P18 Assessment of da Vinci robotic system for paediatric laparoscopic procedures

Abstract Introduction We aimed to evaluate the da Vinci surgical system in its application for robotic-assisted laparoscopic surgery in paediatric patients. Methods A narrative review of the literature on the use of this technology was performed following ENTREQ guidelines using PubMed/Medline, EMBASE, and Google Scholar databases with no setting or language restrictions. Results A total of 16 publications were selected for inclusion. Although the literature on the accuracy and precision of this technology are encouraging, its use in paediatric patients are 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, we identified concerning shortcomings including its bulkiness and lack of force feedback, which lead to procedural injuries notably, tearing of muscles, blood vessels, and nerves, as well as surgical error. For both, we propose sensory haptic feedback systems, soft tissue model, image-guided or virtual reality simulation training to reduce these injury-related complications. However, this does not replace the necessity for “supervised trial and error” operation of the robotic system in surgical settings. Conclusion Innovations in educational training for robotic surgery include tele-presence 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. Take-home message Though promising, the use of the Da Vinci robotic system in children is still emerging and thus warrants further evaluation, training, and development prior to its routine implementation for use.