Tang Yinbing,Gao Zhigang,Xiong Jieni,et al.Safety and feasibility of laparoscopic and robotic-assisted day-surgery resection for benign ovarian tumors in children[J].Journal of Clinical Pediatric Surgery,2025,(06):532-541.[doi:10.3760/cma.j.cn101785-202504023-006]
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Safety and feasibility of laparoscopic and robotic-assisted day-surgery resection for benign ovarian tumors in children

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: Number: 2025年06 Page: 532-541 Column: 专题·机器人手术系统在小儿外科的应用 Date of publication: 2025-06-28
Author(s):
Tang Yinbing1;  Gao Zhigang2;  Xiong Jieni1;  He Min1;  Wu Xuan1;  Meng Jinwen1;  Zhang Lifeng1;  Cai Jiabin1;  Lu Dongfang1;  Liu Ming1;  Wang Yuwei1
1. Department of Surgical Oncology, Children’s Hospital, Zhejiang University School of Medicine, Pediatric Cancer Research Center, National Clinical Research Center for Child Health, Hangzhou 310000, China;
2. Department of General Surgery, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China
Keywords:
Ovarian Tumors; Child; Day Surgery; Minimally Invasive Surgery; Laparoscopic Surgery; Robotic Surgical Procedures; Comparative Study
DOI:
10.3760/cma.j.cn101785-202504023-006
Abstract:
Objective To evaluate the safety and feasibility of laparoscopic and robot-assisted resection of benign ovarian tumors in children performed under a day-surgery model. Methods A retrospective analysis was conducted on clinical data from 327 cases of minimally invasive resection of benign ovarian tumors performed at the Children’s Hospital of Zhejiang University School of Medicine between January 2020 and December 2024.Patients were divided into a laparoscopic surgery group and a robotic surgery group based on the surgical approach.Differences in patient demographics,length of hospital stay,hospitalization costs,operative time,and postoperative complications were compared between the two surgical methods under both day-surgery and non-day-surgery models. Results All 327 pediatric patients successfully underwent minimally invasive resection of benign ovarian tumors.Regardless of whether the procedure was no statistically significant differences (P>0.05) between the day-surgery and non-day-surgery models in terms of patient age,geographic region,unilateral/bilateral tumor distribution,maximum tumor diameter,American Society of Anesthesiologists (ASA) classification,operative time,intra-operative blood loss,drainage tube placement rate,pathological type,postoperative complications,unplanned readmission rate,ipsilateral tumor recurrence,or contralateral new tumor occurrence.In the laparoscopic surgery group,the length of hospital stay and hospitalization cost under the day-surgery model were (24.32±3.63) hours and RMB 9,288±1,752,respectively,compared to (92.52±37.69) hours and RMB 11,860±2,689 in the non-day-surgery model.These differences were statistically significant (P<0.05).In the robotic surgery group,the length of hospital stay and cost under the day-surgery model were (24.62±1.02) hours and RMB 50,258±1,364,respectively,compared to (107.2±52.68) hours and RMB 53,615±2,246 in the non-day-surgery model,also statistically significant (P<0.05).When comparing the robotic and laparoscopic groups,there were no significant differences in hospital stay,operative time,or postoperative complications (P>0.05),though hospitalization costs were significantly higher in the robotic surgery group (P<0.05). Conclusions Minimally invasive laparoscopic or robot-assisted resection of benign ovarian tumors in children is both safe and feasible under the day-surgery model.Compared with the non-day-surgery model,the day-surgery approach yields equivalent treatment outcomes while significantly reducing hospital stay and medical costs.This model is worthy of broader clinical adoption.

References:

[1] Ergun-Longmire B,Greydanus DE.Ovarian tumors in the pediatric population:an update[J].Dis Mon,2024,70(6):101691.DOI:10.1016/j.disamonth.2024.101691.
[2] Skinner MA,Schlatter MG,Heifetz SA,et al.Ovarian neoplasms in children[J].Arch Surg,1993,128(8):849-854.DOI:10.1001/archsurg.1993.01420200023004.
[3] Zhang MX,Jiang W,Li GL,et al.Ovarian masses in children and adolescents-an analysis of 521 clinical cases[J].J Pediatr Adolesc Gynecol,2014,27(3):e73-e77.DOI:10.1016/j.jpag.2013.07.007.
[4] Gonzalez DO,Cooper JN,Aldrink JH,et al.Variability in surgical management of benign ovarian neoplasms in children[J].J Pediatr Surg,2017,52(6):944-950.DOI:10.1016/j.jpedsurg.2017.03.014.
[5] Gonzalez DO,Minneci PC,Deans KJ.Management of benign ovarian lesions in girls:a trend toward fewer oophorectomies[J].Curr Opin Obstet Gynecol,2017,29(5):289-294.DOI:10.1097/GCO.0000000000000400.
[6] Minneci PC,Bergus KC,Lutz C,et al.Reducing unnecessary oophorectomies for benign ovarian neoplasms in pediatric patients[J].JAMA,2023,330(13):1247-1254.DOI:10.1001/jama.2023.17183.
[7] Xu DQ,Gao HY,Yu SZ,et al.Ensuring safety and feasibility for resection of pediatric benign ovarian tumors by single-port robot-assisted laparoscopic surgery using the da Vinci Xi system[J].Front Surg,2022,9:944662.DOI:10.3389/fsurg.2022.944662.
[8] Ljungqvist O,de Boer HD,Balfour A,et al.Opportunities and challenges for the next phase of enhanced recovery after surgery:a review[J].JAMA Surg,2021,156(8):775-784.DOI:10.1001/jamasurg.2021.0586.
[9] Young DG,Carachi R,James H,et al.Legion of Honour France,father of day surgery[J].Scott Med J,2006,51(1):48-50.DOI:10.1258/RSMSMJ.51.1.48.
[10] 卞红强.日间手术初心与实践思考[J].临床小儿外科杂志,2024,23(10):901-905.DOI:10.3760/cma.j.cn101785-202407002-001. Bian HQ.Reflections on original intent and practical issues of day surgery[J].DOI:10.3760/cma.j.cn101785-202407002-001.
[11] 黄娟,李鑫,谢艾洁,等.基于ERAS的卵巢良性囊肿日间手术可行性及安全性分析[J].中国卫生质量管理,2023,30(10):38-42.DOI:10.13912/j.cnki.chqm.2023.30.10.09. Huang J,Li X,Xie AJ,et al.Feasibility and safety analysis of ambulatory surgery of benign ovarian cyst based on the concept of enhanced recovery after surgery[J].Chin Health Qual Manag,2023,30(10):38-42.DOI:10.13912/j.cnki.chqm.2023.30.10.09.
[12] de Luca U,Mangia G,Tesoro S,et al.Guidelines on pediatric day surgery of the Italian Societies of Pediatric Surgery (SICP) and Pediatric Anesthesiology (SARNePI)[J].Ital J Pediatr,2018,44(1):35.DOI:10.1186/s13052-018-0473-1.
[13] 潘守东,王天龙.儿童日间手术的研究进展[J].北京医学,2024,46(6):497-500.DOI:10.15932/j.0253-9713.2024.06.041. Pan SD,Wang TL.Research progress of children’s day surgery[J].Beijing Med J,2024,46(6):497-500.DOI:10.15932/j.0253-9713.2024.06.041.
[14] Mei H,Tang ST.Robotic-assisted surgery in the pediatric surge-ons’ world:current situation and future prospectives[J].Front Pediatr,2023,11:1120831.DOI:10.3389/fped.2023.1120831.
[15] Navarrete Arellano M,Garibay González F.Robot-assisted laparoscopic and thoracoscopic surgery:prospective series of 186 pediatric surgeries[J].Front Pediatr,2019,7:200.DOI:10.3389/fped.2019.00200.
[16] Pachl M,Lautz TB,Aldrink JH,et al.Minimally invasive and robotic-assisted approaches applied to pediatric surgical oncology[J].Pediatr Blood Cancer,2024,72(S2):e31162.DOI:10.1002/pbc.31162.
[17] Neheman A,Kord E,VanderBrink BA,et al.Outpatient robotic surgery in pediatric urology:assessment of feasibility and short-term safety[J].J Urol,2022,207(4):894-900.DOI:10.1097/JU.0000000000002362.
[18] Broch A,Paye-Jaouen A,Bruneau B,et al.Day surgery in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty:is it safe and feasible?[J].Eur Urol Open Sci,2023,51:55-61.DOI:10.1016/j.euros.2023.03.004.
[19] 刘喜旺,范祥明,俞建根,等.日间手术管理模式在达芬奇机器人手术治疗儿童动脉导管未闭中的临床应用[J].中华实用儿科临床杂志,2025,40(1):21-26.DOI:10.3760/cma.j.cn101070-20240727-00477. Liu XW,Fan XM,Yu JG,et al.Clinical application of the day surgery management model in the treatment of patent ductus arteriosus with Da Vinci robotic surgery in children[J].Chin J Appl Clin Pediatr,2025,40(1):21-26.DOI:10.3760/cma.j.cn101070-20240727-00477.
[20] 高跃,谭征.机器人辅助胸腔镜治疗儿童隔离肺日间手术一例报道(附视频)[J].机器人外科学杂志(中英文),2024,5(2):263-268.DOI:10.12180/j.issn.2096-7721.2024.02.026. Gao Y,Tan Z.Robot-assisted thoracoscopic surgery for pulmonary sequestration in pediatric patients undergoing day surgery:a case report (with video)[J].Chin J Robot Surg,2024,5(2):263-268.DOI:10.12180/j.issn.2096-7721.2024.02.026.
[21] Ciro E,Vincenzo C,Mariapina C,et al.Review of a 25-year experience in the management of ovarian masses in neonates,children and adolescents:from laparoscopy to robotics and indocyanine green fluorescence technology[J].Children (Basel),2022,9(8):1219.DOI:10.3390/children9081219.
[22] Esposito C,Blanc T,Di Mento C,et al.Robotic-assisted surgery for gynecological indications in children and adolescents:European multicenter report[J].J Robot Surg,2024,18(1):20.DOI:10.1007/s11701-023-01767-9.
[23] Chen XL,Chen Y,Yang BB,et al.Comparison of robotic vs.laparoscopic treatment in pediatric ovarian benign tumors[J].Langenbecks Arch Surg,2024,409(1):351.DOI:10.1007/s00423-024-03543-1.
[24] Sun L,Zhao DY,Shen YD,et al.Laparoscopic versus robot-assisted pyeloplasty in infants and young children[J].Asian J Surg,2023,46(2):868-873.DOI:10.1016/j.asjsur.2022.09.046.
[25] He M,Liu SG,He ZQ,et al.Robot-assisted resection of renal tumor in children and comparison with laparoscopic surgery[J].BMC Surg,2024,24(1):325.DOI:10.1186/s12893-024-02625-7.
[26] Zhang MX,Chi SQ,Cao GQ,et al.Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children:a systematic review and proportional meta-analysis[J].Surg Endosc,2023,37(1):31-47.DOI:10.1007/s00464-022-09442-0.
[27] Li YY,He SY,Jin Z,et al.Comparison of robot-assisted and laparoscopic-assisted modified Soave short muscle cuff anastomosis surgeries for classical Hirschsprung disease[J].BMC Surg,2025,25(1):78.DOI:10.1186/s12893-025-02799-8.
[28] Jin Y,Cai DT,Zhang SH,et al.Robot-assisted abdominal surgery in children less than 5 months of age:retrospective cohort study[J].Int J Surg,2024,110(2):859-863.DOI:10.1097/JS9.0000000000000867.
[29] 李泸平,张俊杰,张胜利,等.机器人辅助腹腔镜与传统腹腔镜在儿童肾盂成形术的应用价值[J].中华小儿外科杂志,2022,43(1):14-19.DOI:10.3760/cma.j.cn421158-20210227-00093. Li LP,Zhang JJ,Zhang SL,et al.Application value of robot-assisted versus traditional laparoscopic pyeloplasty in children[J].Chin J Pediatr Surg,2022,43(1):14-19.DOI:10.3760/cma.j.cn421158-20210227-00093.
[30] 骆明双,高贺云,易跃雄,等.传统单孔腹腔镜与机器人辅助单孔腹腔镜手术治疗儿童及青少年卵巢良性病变的疗效比较[J].临床小儿外科杂志,2024,23(6):567-571.DOI:10.3760/cma.j.cn101785-202310041-011. Luo MS,Gao HY,Yi YX,et al.Efficacy comparison of conventional laparoscopy versus robot-assisted transumbilical single-incision laparoscopy for benign ovarian lesions in children and adolescents[J].J Clin Ped Sur,2024,23(6):567-571.DOI:10.3760/cma.j.cn101785-202310041-011.
[31] Denning NL,Kallis MP,Prince JM.Pediatric robotic surgery[J].Surg Clin North Am,2020,100(2):431-443.DOI:10.1016/j.suc.2019.12.004.
[32] Huang JR,Huang Z,Mei H,et al.Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions[J].Surg Endosc,2023,37(11):8404-8420.DOI:10.1007/s00464-023-10399-x.

Memo

收稿日期:2025-4-9。
通讯作者:王金湖,Email:wjh@zju.edu.cn

Last Update: 2025-06-28