Application of robot-assisted surgery for the treatment of ovarian teratomas in children

Background. The clinical data of three patients who underwent robotic procedures for ovarian teratoma removal were retrospectively analyzed to investigate the feasibility and safety of this technology in children. Material and methods. The study included children under 18 years of age who underwent surgery using the new Versius robotic platform manufactured by CMR Surgical, UK. The indication for surgery was an established diagnosis of ovarian teratoma. In all cases, three robotic ports were used: one 12-mm trocar for optics (inserted at the level of the umbilicus in an open manner) and two 5-mm trocars for robotic manipulators. An additional 5-mm laparoport was installed for an assistant surgeon to work with during the robotic surgery. In all cases, the principle of ovarian-preserving surgery was observed, which included resection of the formation within healthy tissues, as well as minimal use of coagulation to prevent electrical injury to healthy ovarian tissue and follicles. The surgery involved dissection of the ovarian tunica albuginea over the tumor and enucleation of the formation. During the study, perioperative patient parameters related to demographic data, surgical details, and early and late complications were recorded. Results. The average age of patients at the time of surgery was 11.3±1.5 years (median 11.0 [11.0; 12.0] years), average weight 52.0±12.5 kg (median 56.0 [47.0; 59.0] kg). The affected side was predominantly left (1:2). The average duration of surgery was 85.0±15.0 min (median 85.0 [78.0; 93.0] min), robot installation time was 10—15 minutes. Patients were transferred to the surgery department on average 3.3±0.6 hours (median 3.0 [3.0; 4.0] hours) after surgery. The operations were not accompanied by conversions to laparoscopic or open surgeries. During the surgeries, no complications associated with bleeding from the ovarian tissue or damage to adjacent structures were noted. The average hospital stay was 4.6±2.0 days (median — 4.0 [4.0; 6.0] days). In the remote period at 1, 3, 6 and 12 months after the operation, no significant complications in the form of relapse of disease symptoms were noted. Conclusion. The initial experience of performing robot-assisted operations confirmed that robotics can be safely and effectively used in children with ovarian teratomas.