Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology

Marion Durand, Layla Musleh, Fabrizio Vatta, Giorgia Orofino, Stefania Querciagrossa, Myriam Jugie, Olivier Bustarret, Christophe Delacourt, Sabine Sarnacki, Thomas Blanc, Naziha Khen-Dunlop

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Purpose: Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis. Methods: Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014–2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California). Results: Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication. Conclusions: Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection – useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes.

Original languageEnglish
JournalJournal of Pediatric Surgery
DOIs
Publication statusAccepted/In press - 2020
Externally publishedYes

Keywords

  • Congenital lesions
  • Lobectomy
  • Pediatric
  • Robotic-assisted thoracic surgery
  • Video-assisted thoracic surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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