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 Table of Contents     
Year : 2021  |  Volume : 17  |  Issue : 2  |  Page : 276-277

Considerations for robotic-assisted laparoscopic surgery in children

1 Department of Medical Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
2 Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

Date of Submission27-Dec-2020
Date of Decision06-Jan-2021
Date of Web Publication02-Mar-2021

Correspondence Address:
Dr. Peter Anto Johnson
116 St and 85 Ave NW, Edmonton, AB
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.JMAS_327_20

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How to cite this article:
Johnson PA, Johnson JC. Considerations for robotic-assisted laparoscopic surgery in children. J Min Access Surg 2021;17:276-7

How to cite this URL:
Johnson PA, Johnson JC. Considerations for robotic-assisted laparoscopic surgery in children. J Min Access Surg [serial online] 2021 [cited 2022 Sep 27];17:276-7. Available from:


In the most recent issue of this journal, Sinha et al. suggest promise in the use of the da Vinci surgical system in its application for robotic-assisted laparoscopic surgery in paediatric patients.[1] Although the literature on the accuracy and precision of this technology is encouraging, its use in paediatric patients is still in its early stages and has yet to be explored in great detail. In addition to the technical intricacies, training and learning curve, port placement complications, cost and other limitations identified by the authors, we suggest additional considerations before its large-scale implementation in children.

Of these, the most concerning shortcomings of systems, such as the da Vinci, for surgical procedures are perhaps its bulkiness and lack of force feedback.[2] When combined, these two aspects deal the greatest damage to developing tissues, causing procedural injuries – notably, tearing of muscles, blood vessels and nerves. These injuries are significant, leading to permanent and occasionally serious complications including death, particularly in paediatric patients post-surgery. Novel advancements therefore should consider the compaction and streamlined design of new systems and the incorporation of sensory haptic feedback systems to reduce these injury-related complications.

As with any minimally invasive surgery performed in children, there remains the risk of severe complications resulting from surgical errors. Although soft-tissue models, image-guided and virtual reality simulations and other practical educational training have been associated with reduced error, it never replaces the necessity for 'supervised trial and error' manoeuvring and operating the robotic system on patients in surgical settings.[2] Innovations in educational training for robotic surgery include telepresence surgeries and robotic tele-mentoring, whereby expert surgeons share the same surgical field of view and controls as the training surgeon. In spite of this, there are inevitable risks associated with training when training surgeons must practice through trial and error on real patients and an emphasis must be placed on apposite pre-procedural surgical training.

Furthermore, the universal issue of accessibility and resource availability remains with this technology, perhaps all the more implicated when considering paediatric populations. For instance, while tele-transmission of surgeries is another rapidly expanding field of innovation that may offer us opportunities to enhance accessibility to paediatric populations in low-resource and rural settings, several limitations nevertheless remain.[3] Most significantly, we have observed that high-speed terrestrial networks that use asynchronous transfer mode (ATM), instead of satellite networks, for rapid data transmission are required in such remote locations. While promising, the implementation of ATM networks at hospitals are currently not only limited by resource availability and high cost, but also by legal and ethical concerns surrounding conflict of jurisdiction. As such, progression of robotic surgery for paediatric procedures in low-resource and remote settings also depends on reforms to ethical and legal practice alongside establishing access.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Sinha A, Pathak M, Vig A, Saxena R. Robotic surgery in paediatric patients: Our initial experience and roadmap for successful implementation of robotic surgery programme. J Minim Access Surg 2019;17:32-6.  Back to cited text no. 1
Morris B. Robotic surgery. Applications, limitations, and impact on surgical education. MedGenMed 2005;7:72.  Back to cited text no. 2
Wilson EB, Bagshahi H, Woodruff VD. Overview of general advantages, limitations, and strategies. In: Robotics in General Surgery. New York: Springer; 2014. p. 17-22.  Back to cited text no. 3


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2004 Journal of Minimal Access Surgery
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Online since 15th August '04