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Background: Initial results in pediatric surgery are encouraging, particularly in the field of pediatric urology. However, there is limited experience with its application in infants and neonates. The aim of this study was to compare the feasibility and safety of robotic-assisted surgery in two populations of children, one weighing less and one weighing more than 15.0 kg., Methods: A multicentric study was performed comparing the success of robotic-assisted surgery in patients who weighed less than 15.0 kg (group A) to patients heavier than 15.0 kg (group B), with a total of 178 procedures performed between January 2008 and December 2012. Data concerning the perioperative and intraoperative periods were prospectively collected and retrospectively analyzed., Results: The success of robotic-assisted surgery was compared between group A (62 patients, 11.1 kg) and group B (116 patients, 30.2 kg), with a mean follow-up of 37 months (16-75 months). The conversion rate was superior for group A (5 vs. 2%) and involved three neonatal thoracic procedures. Focusing on three common procedures for both groups (pyeloplasty, partial nephrectomy, and fundoplication), the amount of time for set up was longer for group A (p < 0.05). We found no statistical differences in the mean total operative time and length of hospital stay. The postoperative follow-up revealed similar results for both groups., Conclusions: Cautious adjustments in the patient positioning and trocar placement were necessary in a subset of this pediatric population. For these three particular procedures, with the exception of the longer set up time, the results between the two groups were comparable. These data support the feasibility of robotic-assisted surgery for small children, despite the lack of dedicated instruments.

Objectives: Many studies have reported that robotic-assisted surgery is safe and feasible for paediatric cases. However, very few paediatric thoracic robotic cases have been described. The aim of this study was to share our preliminary experience with robot-assisted thoracic surgery (RATS)., Methods: We reviewed our first, consecutive thoracic robotic procedures between January 2008 and December 2013. Data describing the perioperative and intraoperative periods were prospectively collected in two surgical paediatric centres and then retrospectively analysed. Operation time, completion rate, length of hospitalization and postoperative complications were compared with thoracoscopic results in the literature., Results: Eleven patients were operated on with the robot, and this included operations for oesophageal atresia (3), mediastinal cyst (4), diaphragmatic hernia (2), oesophagoplasty (1) and oesophageal myotomy (1). The mean age at surgery was 72 (range 0-204) months, and the mean weight was 24.4 (range 3.0-51.5) kg. Three of the operations were converted to thoracotomies. The total operation time was 190 (120-310) min, and the average length of hospital stay was 13 (3-35) days. RATS offers similar advantages to thoracoscopy for mediastinal cyst excision in patients weighing more than 20 kg. Appropriate patient positioning and trocar placement were necessary for neonatal patients and thereby resulted in longer preparation times. Despite cautious adjustments, technical feasibility was reduced for low-weight patients., Conclusions: These data support mediastinal cyst excision as a suitable indication for larger children. Currently, there is a lack of evidence that lower weight children, and particularly neonates, are good candidates for RATS., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)