Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology

J Pediatr Surg. 2021 Sep;56(9):1606-1610. doi: 10.1016/j.jpedsurg.2020.11.009. Epub 2020 Nov 12.


Background/purpose: Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis.

Methods: Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014-2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California).

Results: Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication.

Conclusions: Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection - useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes.

Keywords: Congenital lesions; Lobectomy; Pediatric; Robotic-assisted thoracic surgery; Video-assisted thoracic surgery.

MeSH terms

  • Bronchiectasis* / surgery
  • Child
  • Humans
  • Length of Stay
  • Lung Neoplasms* / surgery
  • Pneumonectomy
  • Retrospective Studies
  • Robotic Surgical Procedures*
  • Thoracic Surgery, Video-Assisted
  • Treatment Outcome