Pediatric robotic surgery: issues in management-expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

Abstract

Background: Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally.

Methods: A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place.

Results: During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management.

Conclusion: Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.

Keywords: Anesthesiology; Consensus; Pediatric minimally invasive surgery; Pediatric robotically assisted surgery.

Fig. 1

Summary of recommendations for POV/PONV management in children, including risk identification, risk-stratified prophylaxis, and treatment of established POV. 5-HT3 5-hydroxytryptamine 3, PONV postoperative nausea and vomiting, POV postoperative vomiting, TIVA total IV anesthesia [179]. For permission requests, contact info@aserhq.org

Fig. 2

Risk assessment for venous thromboembolism for adolescents aged 13 years and older: decision-making algorithm from the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). IPC intermittent pneumatic compression, LMWH low molecular weight heparin, TEDs thromboembolic deterrent stockings [187]. (Redrawn by permission from the APAGBI) [187]. [request permission: apagbiadministration@anaesthetists.org]