소아 골반 내 질환에서 로봇 수술 2 예 보고 거대직장, 골반내 림프관종 Clinical Fellow Youngju Hong Department of Pediatric Surgery, Severance Children`s Hospital Department of Surgery,Yonsei University College of Medicine

Robotic surgery in children Use robot assistance for surgery Lancet 1998;351: Nissen fundoplication : 2 cases Surg Endosc 2002;16: pyeloplasty Published robotic surgery total > Pyleoplaty 672 -U.reimplantation 479 -Fundoplication 424 Urol Clin North Am 2004;31: J Pediatr Surg 2013;48:858–865 Background J Am Coll Surg1995;181:552-7

Advantages of the Da Vinci® Surgical System operator can control all the procedure 3-dimensional magnified visualization tremor-free and articulating movements intuitive manipulations motion scaling Disadvantages of robotic surgery high prices bulky robotic system docking problem Background Minimum 4.8 kg ( hiatal hernia) 6.6kg(choledpchal cyst)

Case 1 – Megarectum M/1Y8M, 10.3kg C.C : constipation Birth history –IUP 38+5 wks, 2850g, NSVD Diagnosis –Megarectum –S/P Mini PSARP d/t ARM with perineal fistula

Case 1 – Megarectum

Preoperative diagnosis –Megarectum –S/P mini PSARP d/t ARM with perineal fistula Postoperative diagnosis –Same as above Operation –Da Vinci® robotic low anterior resection with double stapling method Operation time 7:34 Console time 5:50 Case 1 – Megarectum

POD 9 –discharge Last f/u –postoperative 6 months –good Case 1 – Megarectum

Case 2 – Cystic lymphangioma M/5Y5M, 21.4kg C.C : incidental cystic lymphangioma during high ligation, Lt. Birth history –Nonspecific Diagnosis –Cystic lymphangioma in pelvic cavity

Case 2 – Cystic lymphangioma

Preoperative diagnosis –Cystic lymphagnioma –S/P High ligation, Lt. d/t Inguinal hernia, Lt. Postoperative diagnosis –Same as above Operation –Da Vinci® robotic excision of cystic lymphangioma Operation time 4:20 Console time 3:05 Case 2 – Cystic lymphangioma

POD 4 –Discharge with HV OPD f/u –POD 14 –HV removal Case 2 – Cystic lymphangioma

Robotic pelvic surgery in children Safe and feasible Facilitate dissection in a narrow pelvis Useful to preserve ureter, vessel, nerve Conclusions

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