ROBOTIC HERNIORRAPHY IN THE PEDIATRIC POPULATION: AN INTEGRATIVE REVIEW OF THE LITERATURE

Abstract

Robotic herniorrhaphy in children represents a significant advancement in pediatric surgery, offering notable clinical benefits such as reduced tissue trauma, increased surgical precision, and faster postoperative recovery. These advancements are particularly important in pediatric patients, whose bodies are in phases of growth and development, making it crucial to minimize surgical trauma and optimize recovery. Although the initial cost of acquiring and maintaining robotic systems is high, the long-term benefits may justify this investment. Robotic systems, such as the da Vinci, have an initial cost that can range between 1.5 and 2 million dollars, in addition to annual maintenance costs that can reach 200 thousand dollars. These costs are substantially higher than those associated with conventional laparoscopic and open techniques. However, the long-term clinical and economic benefits, such as reduced postoperative complication rates, decreased need for reoperations, and faster recovery, can offset the high initial costs. From a technical standpoint, the correct setup of the robotic system, proper patient positioning, and the use of specific instrumentation are crucial factors for the procedure's success. The precise configuration of the robotic system involves calibrating the instruments and verifying functionality before the surgery begins. Patient positioning, typically in a supine position with a slight Trendelenburg tilt, allows better access to the surgical area and exposure of internal organs. The instrumentation used, including precision graspers and specific suturing devices, is inserted through small ports and remotely controlled by the surgeon from the console. The three-dimensional vision provided by the robotic system allows for precise and safe tissue dissection, reducing the risk of inadvertent damage. Economically, the cost-effectiveness analysis of robotic surgery is complex. Studies indicate that despite the high initial costs, robotic surgery may be more cost-effective than conventional techniques due to better clinical outcomes and faster recovery. The reduction in hospital stay and postoperative complications can result in significant long-term healthcare cost savings. The clinical benefits of robotic surgery include reduced tissue trauma, which translates to less postoperative pain and faster recovery. These factors can lead to lower indirect costs, such as reduced productivity loss for parents caring for their children and lower costs for analgesic medications. The increased precision and better visualization provided by robotic surgery can also reduce the incidence of intraoperative complications and the need for additional treatments, contributing to a favorable cost-benefit ratio. Moreover, robotic surgery offers ergonomic advantages for surgeons, reducing fatigue and improving the precision of movements. The surgical console allows the surgeon to operate in a comfortable position, using intuitive controls to manipulate the robotic instruments, which is particularly relevant in complex and long-duration procedures.