Evaluation of initial experience and comparison of the da Vinci surgical system with established laparoscopic and open pediatric Nissen fundoplication surgery.

摘要

BACKGROUND: Robot-assisted surgery must be evaluated before its acceptance as an option for standard therapy in the pediatric population. Our objective is a comparison of results using the robot system with results for the laparoscopic and open approaches. METHODS: Following IRB approval, robot-assisted procedures were case-matched with controls, selected from 1994 to 2005. Data for 150 Nissen cases were divided equally into 3 groups [robot (R), laparoscopic (L), and open (O)], comparing surgical times, length of hospitalization, and outcomes. RESULTS: The average age (R = 117+/-64 months, L = 107+/-71 months, O = 85+/-55 months, P<0.05) and weight (R = 37+/-23 kg, L = 33+/-24 kg, O = 24+/-17 kg, P<0.05) of the open group were lower comparatively. Robot operative times proved significantly longer compared with laparoscopic and open time (R = 160+/-61 min, L = 107+31 min, O = 73+/-27 min, P<0.05). The robot had 2 conversions (2/50, 4%), comparable to the laparoscopic conversion rate (1/50, 2%). Open cases resulted in longer hospitalization [R = 2.94+/-4.5 days, L = 3.54+/-7.8 days, O = 3.5+/-2.8, P<0.05]. Complication rates were equivalent between groups. The most common complication with the da Vinci and laparoscopic approaches was tight wrap requiring dilation [R = 4/50 (8%) and L = 3/50 (6%)]. CONCLUSION: Robot-assisted surgery is equivalent to standard laparoscopic surgery in terms of complications and length of stay, with both having significantly increased operation times but reduced length of stay compared with open surgery. Further experience with this technology is needed to overcome the learning curve and reduce operative times.