Robot-assisted appendectomy in a child — a case report

BACKGROUND: Acute appendicitis is the most common surgical pathology requiring emergency intervention in children worldwide. The gold standard in the treatment of the disease is laparoscopic appendectomy. At the same time, advances in technology increasingly incline specialists to the introduction of robotic systems in surgical practice. This fact once again confirms the importance of research aimed at determining the feasibility of using robot-assisted appendectomy in emergency surgery in children. CLINICAL CASE DESCRIPTION: The authors made a retrospective review of the medical history of a child with acute appendicitis. A 11-year-old boy was admitted to the Irkutsk State Regional Children's Clinical Hospital with abdominal pain in the right iliac region. At the time of admission, disease duration was 20 hours. For surgery, the Versius robot manufactured by CMR company (UK) was used. Robot-assisted appendectomy followed the same principles as those used in open or laparoscopic approaches: (1) appendix exposure, (2) mesoappendix bipolar coagulation, (3) appendix removal using an endoscopic mechanical stapler. The total surgical time was 30 minutes, out of which the robot installation time was 10 minutes and the main console time was 20 minutes. The entire procedure was performed completely intracorporally and without conversion to laparoscopic or open surgery. There were no any intraoperative problems and complications. The surgery was successful. Patient’s enteral feeding started on the same day after the surgery. He was discharged from the hospital on Day 3 day after the surgery. Ultrasound of the abdominal cavity, performed 1 month later, did not reveal any signs of abnormalities observed at this age. The patient did not complain of any digestive problems during the entire observation period for 3 months after the surgery. CONCLUSION: Robotic appendectomy has its advantages and disadvantages in the treatment of acute appendicitis. Robotics provides faster postoperative recovery of patients, but requires longer time for surgery; besides, it is an expensive surgical intervention. However, over time the robot-assisted appendectomy may become a cost-effective one that will be successfully used by all surgeons, as it happened with laparoscopic appendectomy several decades ago.