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Page 10 of 12 Navarrete-Arellano. Mini-invasive Surg 2020;4:9 I http://dx.doi.org/10.20517/2574-1225.2019.70

ganglioneuroblastoma, a teratoma, and an inflammatory mass of unclear etiology. They concluded the
robotic surgery is safe and effective for resecting solid mediastinal tumors. The application of RATS in
malignant solid tumors in children in selected cases is an option, but oncological surgical principles should
be applied.

Due to the low frequency of thoracic surgery in children, it was difficult to include a control or comparative
group in our study, this being its main weakness.

According to the detailed non-systematic review of previous publications in PubMed on non-
cardiovascular thoracic pathology treated with robotic surgery in the pediatric population worldwide,
currently, the number of children treated with this technology barely has reached 100 cases, and all related
references with the theme are included [11,22,26-34,36,39,44,45] .

In conclusion, This pediatric series of RATS reports a small number of patients according to the low
percentage of thoracic surgery in this population. The most frequent surgical techniques performed by
RATS in children are: lobectomy, resection of benign masses and mediastinal cysts, thymectomy, plication,
and closure of diaphragmatic defects. RATS in newborns and infants is a very difficult technique when
they weigh between 3 and 5 kg, and patients under 3 kg are not candidates for this approach at present.
Based on currently available evidence, it is not possible to suggest recommendations for the use of MIS for
the treatment of intra-thoracic malignant tumors in children, including the robotic surgery. Currently, few
children with malignant tumors treated with RATS have been reported. Its application in selected cases
is an option, but oncological surgical principles should be applied. Our results are encouraging in RATS,
although our experience is limited to a few cases. Robotic surgery for the treatment of thoracic pathology
is feasible and safe, and has advantages. To date, few pediatric surgeons worldwide have applied RATS in
children.

DECLARATIONS
Acknowledgments
I thank the Pediatricians and Pediatric Surgeons of the Department of Pediatrics of the Hospital Militar
de Especialidades de la Mujer y Neonatología of Mexico City, as well as, to the resident physicians of
the specialty of Pediatric Surgery, for their collaboration in referring patients for treatment with robotic
surgery, also all those who collaborated in the surgical teams.

Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
The author cannot share the data according to the policy of the hospital institution, for reasons of
confidentiality.

Financial support and sponsorship
None.

Conflicts of interest
The author declares to be Proctor of the da Vinci Surgical System and sometimes receives salary for advice
to Surgeons in their first robotic procedures, from the marketing company in my country, as part of the
support in the training of surgeons by this company. However, in relation to the treatment of patients and
the execution of this manuscript, no economic financing was received from commercial companies.