Discover the definition and scope of Robotic Pediatric Surgery. Learn about the Da Vinci Robotic Surgery System the role of the pediatric surgeon and the benefits for children.
Overview and Definition
What Is Robotic Pediatric Surgery?
Robotic Pediatric Surgery is a specialized field of medicine that utilizes advanced robotic systems to perform surgical procedures on infants children and adolescents. This innovative approach allows pediatric surgeons to execute complex procedures with greater precision flexibility and control than is possible with conventional open or laparoscopic techniques.
The robotic system serves as a sophisticated tool that replicates the hand movements of the surgeon on a smaller scale inside the body of the small patient. It is widely used for treating various conditions affecting the urinary tract digestive system and chest in children. This field has revolutionized pediatric surgery by significantly reducing physical trauma to the child which leads to faster recovery times and better clinical outcomes.
Scope and Advantages
The scope of robotic surgery in children covers conditions such as ureteropelvic junction obstruction, vesicoureteral reflux, and various congenital cysts or tumors. The primary advantage is the enhanced visualization and dexterity provided by the robotic platform.
For a child, the benefits of minimally invasive surgery are profound: significantly reduced blood loss, smaller scars which are important as the child grows, and a much shorter hospital stay compared to open surgery. The stability of the robotic arms eliminates natural hand tremors, making it safer for dissecting tissue around vital structures like nerves and blood vessels in a small child’s body.
Purpose and Clinical Use
Conditions Evaluated via PCR and Endoscope
Children requiring surgery often present with congenital anomalies detected prenatally or symptoms that develop in early childhood. Common signs include recurrent urinary tract infections, abdominal masses, or difficulty breathing. In cases of suspected infections or genetic conditions associated with tumors, PCR (Polymerase Chain Reaction) testing is utilized to identify specific genetic markers or pathogens with high sensitivity.
This helps determine if a condition is hereditary or infectious before surgery. For gastrointestinal or airway issues, an Endoscope is often used initially to visually inspect the internal organs, helping doctors correlate symptoms like dysphagia or reflux with anatomical defects that may require robotic correction.
Candidates and Risk Assessment
Not every child is a candidate for robotic surgery. The size of the patient is a critical factor; while technology has advanced to operate on infants, there are weight and size limits for the safe placement of robotic ports. A thorough risk assessment is conducted to ensure the child can tolerate the anesthesia and the duration of the procedure.
Risk factors such as congenital heart defects or lung issues must be carefully managed. However, for many complex reconstructive surgeries, the robotic approach is now considered the gold standard due to its ability to perform precise suturing in deep, small spaces that are hard to reach with conventional laparoscopy.
Advanced Imaging with 3 Tesla MR and Computed Tomography 256 Slice
Accurate anatomical mapping is vital before operating on a child. 3 Tesla MR is the preferred imaging modality for soft tissue evaluation because it provides ultra-high-resolution images without exposing the child to ionizing radiation. It is essential for mapping complex tumors or spinal defects. When detailed vascular mapping or assessment of bone structure is required, Computed Tomography 256 Slice scanners are used. These ultra-fast scanners can capture detailed images in a fraction of a second, which is particularly beneficial for children who may have difficulty holding still, often reducing the need for deep sedation.
Initial Assessment using Ultrasonography
The diagnostic journey often begins with Ultrasonography. It is the most common first-line diagnostic tool in pediatrics because it is non-invasive, painless, and radiation-free. Ultrasound is excellent for detecting kidney blockages, abdominal masses, or fluid collections. While it provides a good initial picture, the more advanced cross-sectional imaging of MRI and CT is usually required for surgical planning to ensure the robotic instruments can be navigated safely around the child’s organs.
Surgery and Recovery
Procedures with Da Vinci Robotic Surgery System
The core of the treatment involves the Da Vinci Robotic Surgery System. This platform provides the surgeon with a 3D high-definition view of the surgical field, magnified ten times. This magnification is critical when suturing tiny structures, such as reconnecting a ureter to the kidney in a small child. The system’s “wristed” instruments bend and rotate far more than the human wrist, allowing the surgeon to work around corners and in tight spaces within the pediatric chest or abdomen. This capability is used for procedures like pyeloplasty, fundoplication, and tumor resections, ensuring precise removal of pathology while sparing healthy growing tissue.
Functional Monitoring with PET CT and Spect CT
For pediatric oncology patients or those with complex kidney issues, functional imaging is integrated into the treatment plan. PET CT helps distinguish between active tumor tissue and scar tissue, guiding the surgeon on how much tissue needs to be removed. Spect CT is often used in urology to assess kidney function and drainage. It provides functional data that tells the surgeon how well a kidney is working, which is crucial when deciding whether to repair or remove a damaged organ. These technologies ensure that the surgical approach is not just anatomically correct but also functionally beneficial for the child’s long-term health.
Follow-up and Support
Post-Surgical Recovery and Growth
Recovery for children after robotic surgery is often surprisingly fast. Most are up and moving within a day, and pain management is typically easier compared to open surgery. Long-term care focuses on monitoring the child’s growth and development to ensure the surgery has no lasting negative impact. Follow-up appointments often involve radiation-free imaging like Ultrasonography to check for recurrence of issues like kidney blockage.
Quality of Life
The ultimate goal of robotic pediatric surgery is to fix the problem with as little impact on the child’s life as possible. By minimizing scarring and tissue damage, children can return to school and play much sooner. Long-term outcomes for conditions like robotic pyeloplasty are excellent, with high success rates in relieving obstruction. Support from pediatric specialists ensures that the child’s physical and emotional needs are met as they recover and grow.
Purpose and Clinical Use
Purpose Of Robotic Systems In Pediatrics
The core purpose of using robotic systems in pediatrics is to perform complex surgeries through small incisions without compromising on the quality of the result or the precision of the reconstruction. Children have small abdominal and thoracic cavities containing vital organs packed closely together. Navigating this space requires immense care to avoid damaging healthy structures.
The robotic system allows surgeons to reach deep areas such as the renal pelvis or the deep pelvis with ease. The purpose extends beyond just fixing a defect it aims to preserve function and growth potential which directly impacts the future quality of life of a child.
Clinical Use In Pediatric Urology
Robotic surgery is most commonly applied in pediatric urology. One of the flagship procedures is robotic pyeloplasty used to treat ureteropelvic junction obstruction which is a blockage where the kidney meets the ureter. The robot allows the surgeon to cut out the narrowed segment and sew the urinary tract back together with watertight precision.
This delicate suturing is difficult with standard laparoscopy but the Da Vinci Robotic Surgery System makes it straightforward. This procedure saves the kidney from damage and restores normal urine flow.
Treating Vesicoureteral Reflux
Another common urologic condition is vesicoureteral reflux where urine flows backward from the bladder to the kidneys causing infections and damage. Robotic ureteral reimplantation is performed to fix the valve mechanism at the bladder. The surgeon creates a new tunnel for the ureter to stop the reflux.
The dexterity of the robotic instruments allows for precise dissection and suturing inside the small pediatric bladder or outside it reducing bladder spasms and the need for long term catheters compared to open surgery.
Clinical Use In General Surgery
In pediatric general surgery robotics is used for a variety of abdominal conditions. One key application is the removal of choledochal cysts which are congenital cysts of the bile duct. The surgery involves removing the cyst and reconstructing the connection between the liver and the intestine. The robotic platform facilitates this complex reconstruction known as a hepaticojejunostomy ensuring a leak free connection. This minimally invasive approach reduces the risk of future bowel obstructions caused by scar tissue.
Robotic Fundoplication For Reflux
For children with severe gastroesophageal reflux disease or GERD who fail medical management robotic fundoplication is an option. The surgeon wraps the top part of the stomach around the lower esophagus to strengthen the valve and prevent acid reflux. The magnified 3D view helps the surgeon identify and protect the vagus nerves and blood vessels near the stomach. This procedure provides relief from reflux symptoms and protects the esophagus from damage while avoiding a large abdominal incision.
Clinical Use In Thoracic Surgery
In the chest robotic surgery is used to treat lung masses and mediastinal tumors. A robotic resection involves removing a portion of the lung or a mass like a bronchogenic cyst. The robotic instruments allow the surgeon to dissect the delicate blood vessels and airways of the lung without spreading the ribs as is done in open surgery. This results in dramatically less pain and a quicker return to normal breathing function which is crucial for active children.
Advantages In Pediatric Oncology
Robotic surgery is increasingly being used for the resection of pediatric tumors such as neuroblastomas or Wilms tumors when appropriate. The precision of the robot is particularly useful for dissecting tumors away from major blood vessels like the aorta or vena cava. While open surgery remains the standard for very large tumors the robotic approach offers a viable option for smaller well defined masses allowing for a complete resection with clear margins and a faster recovery for chemotherapy or radiation if needed.
Reconstructive Procedures With Endoscope
While the robotic system uses its own camera it is often used in conjunction with a flexible Endoscope during certain procedures. For example during airway reconstruction or complex urologic repairs an Endoscope may be used to verify the internal anatomy while the robot works externally. This combined approach ensures that the repair is perfect both inside and out. The robot capability to handle fine sutures makes it the preferred tool for these delicate reconstructive tasks ensuring optimal functional results.
Treating Spleen And Gallbladder Issues
Robotic splenectomy and cholecystectomy are performed for blood disorders and gallbladder disease respectively. While laparoscopic removal is common the robotic platform offers advantages in complex cases such as a very large spleen or complicated gallbladder anatomy. The stable camera and extra working arm allow the surgeon to control the tissues better reducing the risk of bleeding. This safe and effective removal helps children with conditions like sickle cell disease or hereditary spherocytosis manage their health with less surgical impact.
Who Is A Candidate For Surgery?
Most children who are eligible for minimally invasive surgery can undergo robotic surgery. However the size of the child is a critical factor. The abdomen must be large enough to accommodate the robotic ports and allow for instrument movement. Typically infants older than six months or weighing more than eight to ten kilograms are candidates but this varies by center and surgeon experience. A thorough evaluation ensures the right patient receives the right surgery maximizing the chance of success while minimizing risks.
Evaluation Before Treatment
Initial Consultation And History
The evaluation process begins with a detailed consultation with the pediatric surgeon. The doctor will review the complete medical history of the child including prenatal history previous surgeries and current symptoms. Parents will be asked about pain infections or functional issues. This initial step establishes the need for surgery and identifies any potential risks. The doctor will explain why robotic surgery is the recommended course of action based on this history and perform a physical examination to check the general health status of the child.
Diagnostic Imaging With Ultrasonography
Ultrasonography is often the first line imaging modality in pediatrics because it is radiation free and painless. It uses sound waves to create images of internal organs. In urology it is used to assess kidney size dilation of the renal pelvis and the bladder.
For abdominal pain it can evaluate the gallbladder liver and spleen. The ultrasound provides a good initial roadmap and helps monitor conditions over time. It helps the surgeon decide if more advanced imaging is needed for surgical planning.
Advanced Imaging With 3 Tesla MR
3 Tesla MR or 3T MRI represents the gold standard in magnetic resonance imaging without radiation. In pediatric care it is particularly useful for evaluating complex anatomical defects in the brain spine and pelvis. It uses a powerful magnetic field to create highly detailed images of soft tissues.
The high resolution allows the surgeon to see the exact anatomy of tumors or congenital malformations. This precise mapping aids in surgical planning and helps determine the best approach for the robotic instruments.
Diagnostic Imaging With Computed Tomography 256 Slice
The Computed Tomography 256 Slice scanner is an ultra fast CT machine that captures detailed cross sectional images of the body. In complex pediatric cases such as tumors or severe trauma it is used to visualize anatomy and blood vessels. The speed of the scan reduces the need for sedation in some children as it captures images in a fraction of a second. This roadmap is vital for the surgeon to plan the robotic surgery allowing them to identify the exact location of the pathology relative to vital structures.
Functional Evaluation With Spect CT
Spect CT or Single Photon Emission Computed Tomography combined with CT provides functional information about organs especially the kidneys. It is widely used in pediatric urology to assess kidney function and drainage. By using a tracer called MAG3 or DMSA the test shows how well each kidney is filtering blood and if there is an obstruction. This functional data is crucial for deciding if a kidney needs repair via Robotic Pediatric Surgery or if it should be removed if function is negligible.
Metabolic Imaging With PET CT
PET CT combines positron emission tomography with computed tomography. In pediatric oncology it is used to stage cancer by assessing metabolic activity. It uses a radioactive sugar tracer to light up areas of high metabolic activity which are often cancer cells. This scan is highly sensitive for detecting if a tumor has spread to lymph nodes or other organs. A positive PET CT might change the treatment plan from surgery to chemotherapy first. It is a critical tool for accurate staging in cancer cases.
Genetic Testing And PCR Analysis
PCR or Polymerase Chain Reaction is a laboratory technique used to amplify DNA sequences. In pediatric medicine it is used for genetic testing of congenital syndromes or tumors. Understanding the genetic profile of a condition can influence treatment decisions. for example certain genetic mutations might indicate a predisposition to multiple tumors requiring a different surgical strategy. PCR testing of tissue or blood samples provides molecular level insights that guide personalized treatment strategies for the child.
Pre-Operative Health Clearance
Before undergoing robotic surgery children must undergo a general health clearance. This involves blood tests to check for anemia clotting ability and organ function. An anesthesiologist who specializes in pediatrics will review the airway and allergy history of the child. Medications may need to be adjusted. This comprehensive assessment ensures maximum safety during the operation and smooth recovery from anesthesia. The goal is to optimize the child’s health before they enter the operating room.
The Role Of The Endoscope In Evaluation
Sometimes diagnostic procedures are needed before the main surgery. A cystoscopy using a small pediatric Endoscope may be performed to look inside the bladder and urethra. This helps confirm the anatomy for urologic conditions like reflux or valves. In gastrointestinal cases an upper or lower endoscopy might be done to visualize the lining of the gut. These direct visualizations complement the radiologic imaging and confirm the surgical plan.
Preparing The Child And Family
In the days leading up to the surgery parents receive specific instructions. This may include diet changes or bowel preparation. The most critical instruction is fasting meaning no food or drink for a specific time before surgery to prevent aspiration during anesthesia. The care team also prepares the family psychologically explaining the process simply to the child if age appropriate. Child life specialists may be involved to reduce anxiety through play and education.
Surgery and Recovery
Arrival And Preparation
On the day of surgery the child and parents arrive at the hospital admission unit. Nursing staff verify the identity of the patient and the scheduled procedure. An IV line is placed to deliver fluids and medications often after using numbing cream to minimize pain. The surgeon and anesthesiologist visit to answer final questions and mark the surgical site. This preparation phase is designed to be as calm as possible often involving toys or tablets to distract the child before entering the operating room.
Anesthesia And Positioning
Once in the operating suite the child is given general anesthesia to induce deep sleep. A breathing tube is placed to control respiration. The surgical team then carefully positions the small patient.
For urologic surgeries the child is often placed on their side. Proper padding is used to protect pressure points and keep the child warm. The positioning allows gravity to move organs away from the surgical field providing a clear view for the robot.
Port Placement And Docking
The surgeon makes several tiny incisions or ports in the skin usually five to eight millimeters wide. The robotic camera and instrument arms are inserted through these ports. The Da Vinci Robotic Surgery System cart is then driven up to the operating table and docked or attached to these ports.
The surgeon then scrubs out and sits at the control console while a surgical assistant stands by the patient to change instruments and assist with suction or clip application.
Performing The Surgery With Da Vinci Robotic Surgery System
The surgeon performs the operation by manipulating the master controls at the console. The Da Vinci Robotic Surgery System translates these movements into precise actions inside the child’s body. For reconstructive surgery the surgeon meticulously cuts and sews delicate tissues. The 3D high definition vision allows for identification of tiny vital structures preventing accidental damage. The precision is unmatched by human hands alone ensuring thorough correction of the defect.
Intraoperative Use Of Endoscope
During certain procedures such as checking a ureteral repair or looking for a connection a sterile Endoscope might be used simultaneously. The assistant may insert the scope to shine a light or inject fluid verifying that the robotic repair is watertight and patent. This dual modality approach ensures immediate quality control of the surgery before the child even leaves the operating room reducing the risk of complications.
Specimen Removal And Closure
If a cyst or organ needs to be removed it is placed inside a specialized retrieval bag within the body. One of the small incisions is slightly enlarged to pull this bag out. This prevents fluid spillage or tissue contact with the skin. The robotic arms are undocked. The small incisions are closed with dissolvable sutures under the skin and covered with surgical glue or sterile strips. This means there are no stitches to remove later which is less traumatic for the child.
The Recovery Room Experience
The child is transferred to the Post Anesthesia Care Unit or PACU. Here specialized pediatric nurses monitor vital signs and oxygen levels continuously. It is normal for the child to be groggy or emotional as they wake up. Pain is managed with IV medication. Parents are usually allowed into the recovery room as soon as the child is stable to provide comfort. Most children spend about one to two hours here before moving to a room.
Pain Management And Mobilization
Pain after robotic surgery is generally manageable and significantly less than open surgery because muscles are not cut. Most children utilize a pain control strategy including oral medications and sometimes nerve blocks placed during surgery. The nursing team encourages early mobilization. Even small children are encouraged to sit up or walk with assistance soon after surgery. Movement is crucial to prevent complications and speed up the return of bowel function.
Diet And Hydration
The digestive system slows down during anesthesia. Children start with ice chips clear liquids or breast milk/formula. As bowel sounds return the diet is advanced to solid foods. This progression is cautious to prevent nausea. Hydration is encouraged to flush the anesthesia from the system. Most children tolerate a regular diet by the morning after surgery which allows for the removal of the IV line.
Discharge From Hospital
The hospital stay for robotic surgery at Liv Hospital is short relative to open surgery. Many children go home within twenty four to forty eight hours depending on the procedure. Discharge criteria at Liv Hospital include controlled pain ability to tolerate food and normal vital signs. Parents receive a discharge summary from Liv Hospital with instructions on wound care bathing and when to call the doctor. The quicker return to home allows children to recover in their own familiar environment with the support of Liv Hospital.
Follow-up and Support
Pathology Results Review
If tissue was removed during surgery reviewing the pathology report is the first step. The tissue is examined by a pathologist to confirm the diagnosis such as a benign cyst or a specific type of tumor. The surgeon explains these findings to the parents usually within a week of surgery. This report confirms whether the surgery was curative or if additional monitoring is needed. For most reconstructive surgeries there is no pathology but the surgical outcome is reviewed.
Monitoring With Ultrasonography
Long term monitoring is essential for children especially for urologic conditions. Ultrasonography is the primary tool for this surveillance. It is painless and radiation free. Regular ultrasounds check the kidneys and bladder to ensure the blockage is gone and the hydronephrosis (swelling) is improving.
These visits are typically scheduled at one month three months and then annually. The non invasive nature makes it easy for children to tolerate repeated exams.
Advanced Monitoring With 3 Tesla MR
For more complex conditions or tumor surveillance 3 Tesla MR might be used in the follow up period. This provides detailed anatomical information without radiation risks. It ensures that tumors have not recurred or that complex reconstructions are healing as expected.
The high definition images give the surgeon confidence in the long term success of the procedure. Monitoring protocols are tailored to the specific condition of the child.
Functional Follow-Up With Spect CT
In cases involving kidney function follow up Spect CT scans may be performed to quantify improvement. If a kidney had poor function before surgery this test checks if the function has stabilized or improved after the obstruction was removed. This objective data is crucial for long term renal health management. The frequency of these scans is minimized to reduce radiation exposure relying more on ultrasound when possible.
Wound Care And Scar Management
The small incisions from robotic surgery heal quickly. Parents are instructed to keep the area clean and dry. The surgical glue usually peels off on its own after a couple of weeks. Once the wounds are fully healed parents can use silicone sheets or creams to minimize scarring further although robotic scars are already minimal. Watching for signs of infection like redness or fever is part of home care.
Recovering Physical Activity
Recovery from robotic surgery is swift. Most children can return to school within a week. However rough play and contact sports are usually restricted for about four to six weeks to allow the internal tissues to heal completely. The surgeon will provide specific guidelines based on the surgery performed. Walking and light play are encouraged immediately to prevent stiffness and promote healing.
Nutritional Support
Good nutrition helps the body heal. A balanced diet with plenty of protein and vitamins is recommended. For infants resuming regular feeding schedules is a priority. Preventing constipation is also important after abdominal surgery so plenty of fluids and fiber are encouraged. If specific dietary restrictions apply such as for gastrointestinal surgeries a dietitian will guide the family through the transition.
Emotional Support For The Child
Surgery can be a scary experience for a child. Some children may have nightmares or be clingy after the procedure. This is a normal reaction to stress. Patience and reassurance from parents are key. Maintaining routines helps the child feel secure. If anxiety persists the hospital can provide resources or referrals to child psychologists who specialize in medical trauma.
Long-Term Health Maintenance
Regular follow up visits are crucial for maintaining long term health. These visits allow the surgeon to monitor growth and development ensuring the surgery has no negative impact. For urologic patients monitoring blood pressure and urine for protein is part of long term kidney health maintenance. The goal of follow up is to ensure the child grows up healthy and active with no limitations from their condition.
Why Choose Liv Hospital?
Choosing a center like Liv Hospital with a dedicated robotic pediatric program ensures access to the latest technology and experienced surgeons. The combination of the Da Vinci Robotic Surgery System at Liv Hospital with child centered care leads to superior outcomes. The multidisciplinary team at Liv Hospital including pediatricians radiologists and nurses collaborates on every case. This comprehensive approach at Liv Hospital provides personalized care plans ensuring the best possible journey from diagnosis to full recovery for your child.
FREQUENTLY ASKED QUESTIONS
Does the robot operate on its own?
No the robot is entirely controlled by the pediatric surgeon and cannot make any movements or decisions independently at any time.
Is robotic surgery safe for small children?
Yes it is considered safe and effective for many pediatric procedures offering reduced risks of infection and pain compared to open surgery.
What is the main advantage of the Da Vinci Robotic Surgery System?
The main advantages are the 3D high definition vision and the precision of the wristed instruments that allow complex work in small spaces.
Are the incisions large?
No the incisions are very small usually less than one centimeter in length which minimizes scarring and speeds up recovery.
How long has this technology been used for kids?
The robotic system has been used in pediatric surgery since the early 2000s and has been performed on thousands of children worldwide.
What is the most common robotic pediatric surgery?
Robotic pyeloplasty for kidney blockage is the most widely performed robotic procedure in pediatric urology due to its high success rate.
Does robotic surgery cure reflux?
Yes robotic ureteral reimplantation effectively cures vesicoureteral reflux preventing kidney infections and long term damage.
Is robotic surgery better for bile duct cysts?
Yes it allows for precise reconstruction of the bile ducts offering a minimally invasive option for a complex major surgery.
Can the robot be used for lung surgery in kids?
Yes it is used for removing lung cysts and tumors offering less pain and avoiding rib spreading compared to open surgery.
Why is the robot better for sewing?
The wristed instruments mimic the human hand allowing for precise knots and watertight closures which is hard with straight sticks.
Why is Ultrasonography preferred for kids?
It is painless safe and does not use ionizing radiation making it the ideal first test for developing bodies.
Is the CT scan safe for children?
Yes modern scanners use dose reduction software to minimize radiation and the diagnostic benefit for surgery is significant.
What does Spect CT tell the doctor?
It tells us exactly how much work each kidney is doing which helps us decide whether to repair or remove a damaged kidney.
Why do I need a 3 Tesla MR?
It provides the most detailed pictures of soft tissues without radiation which is essential for planning complex surgeries.
How long does the evaluation take?
It varies but typically all necessary scans and consultations are completed within a week or two to avoid delays in treatment.
Will my child be in a lot of pain?
Pain is generally moderate and well controlled with medication it is significantly less than open surgery because of the tiny incisions.
When can my child walk after surgery?
We encourage walking or moving around the same day or the next morning to help recovery and make them feel better.
How long does the surgery take?
It varies by procedure but typically robotic surgeries take between two to four hours depending on the complexity.
Do they need a catheter?
For some urologic surgeries a temporary catheter may be needed but it is often removed before discharge or shortly after.
How big are the scars?
The scars are tiny dots usually less than a centimeter each and they fade very well over time often becoming invisible.
Why do we need follow up ultrasounds?
To ensure the repair is working well and the organ is healing properly without exposing your child to radiation.
When can my child go back to school?
Most children feel well enough to return to school within 5 to 7 days after robotic surgery.
Will the scars disappear?
While they never completely disappear they fade significantly and become very faint often blending in with skin lines.
Is 3 Tesla MR safe for follow-up?
Yes it is very safe as it uses magnets not radiation providing detailed views for complex monitoring.
Can my child play sports again?
Yes after the initial healing period of about 4 to 6 weeks children can return to all normal activities including sports.
No the robot is entirely controlled by the pediatric surgeon and cannot make any movements or decisions independently at any time.
Yes it is considered safe and effective for many pediatric procedures offering reduced risks of infection and pain compared to open surgery.
The main advantages are the 3D high definition vision and the precision of the wristed instruments that allow complex work in small spaces.
No the incisions are very small usually less than one centimeter in length which minimizes scarring and speeds up recovery.
The robotic system has been used in pediatric surgery since the early 2000s and has been performed on thousands of children worldwide.
