"Unlike many adult surgeries, where they are removing organs, most of our surgeries involve reconstruction," says Dr. Nguyen. "A lot of the reconstruction requires very delicate suturing and because of that, the robot was just perfect."

When performing any surgical procedures on children, special considerations must be taken into account. When the robot first came out, a lot of people thought it was "overkill" for pediatric surgery, says Dr. Nguyen.


"But what we found is, no matter what the size of the patient, you can do things safely as long as you have a team that works with the robot regularly," he says.

For example, adults can sustain the weight of the robot's arms on their bodies because of ample fat and muscle, but this can cause injury to a child. The extent of laparoscopy can also be minimized with the work of anesthesiologists, who use carbon dioxide to inflate the abdomen to create room for the robotic arms. The anesthesiologists must have a firm grasp of pediatric physiology to ensure that the anesthesia is administered safely.

The average patient at Children's Hospital Boston is about 3 to 4 years old, but the number tends to change with the advancements in robotic techniques.

"Around the country, most people who do pediatric robotic surgery are using it for pyeloplasty. For us, we expand to so many other indications that the age varies significantly," says Dr. Nguyen.

So far, Dr. Nguyen's youngest surgical patient was about 3 months old.

Learning the ways of the robot
With any surgical procedure, practice is key in mastering the technique and robotic surgery is no exception.

"Robotic surgery does have a significant learning curve," says Dr. Patel. "It's not really technology itself alone, actually the experience of the surgeon performing the procedure is more important than the technology itself."

There are currently 20 robotic surgery training centers across the United States, according to Intuitive Surgical, Inc. As of yet, there are no formalized guidelines from any of the major medical societies or associations about robotic surgery standards. It's an internal and hospital specific process.

"People have actually done research in terms of what the minimal case volume need to be in order to be at least somewhat facile with this particular technique," says Dr. Mayer. "The general rule is that the surgeon should be doing at least 20 of these a year and have done at least 100 cases to be reasonably comfortable with this particular technique."

One of the training centers is at Children's Hospital Boston, where physicians of all specialties are trained to do robotic surgery. The trainee first goes through a standard online training course, then performs inanimate work on pegs and then moves on to an animal model (a pig). Once the surgeon learns how to do the procedures on the animal, a minimum of five cases is proctored. Depending on the level of comfort after that, the surgeon either moves on to solo surgeries or continues working with a mentor.

More Industry Headlines