Collection
Minimally Invasive and Robotic Surgery
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
With trained personnel, room turnover time for robotic surgery equals that of laparoscopic surgery. — Juan Gurria, Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most? · 2:37
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
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This video series recaps highlights from the 13th Annual Pediatric Surgery Update Course. Dr.
podcast4:35 · Oct 2026
A five-minute timer approach is reasonable when attempting SILS, and if not making significant progress after 10 minutes, conversion to traditional three-port laparoscopy should be considered. — Rosen, Single incision laparoscopic appendectomy technique and instrumentation · 7:35
Appendectomy1 item
Single incision laparoscopic appendectomy technique and instrumentation
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In this video Dr. Nelson Rosen from Cincinnati Children's Hospital shows an appendectomy using a single laparoscopic incision .
Necessary Equipment for a SILS appendectomy:
12 millimeter trocar (for the Umbilicus)
10mm Laparoscope with
video11:27 · Nov 2026
Inguinal Hernia1 item
Laparoscopic inguinal hernia inversion and ligation in female children: a review of 173 consecutive cases at a single institution
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Purpose: Laparoscopic inguinal hernia inversion and ligation (LIHIL) is a method of hernia repair in which the hernia sac is inverted into the peritoneal cavity and subsequently ligated and excised. Since 2003, 5 surgeons at our institution
article · Nov 2026
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Robotic platforms offer technical advantages over laparoscopy, including 7 degrees of freedom versus the human hand's 6, superior depth perception, and reduced surgeon fatigue. The learning curve favors robotics: basic proficiency requires 10–15 cases compared to 20–30 for laparoscopy, with faster time-to-competency in reducing operative duration. Emerging haptic feedback systems can detect impending suture rupture. Clinical outcomes show reduced postoperative pain, infection risk, and faster recovery, with oncologic results equivalent to laparoscopy. In colorectal surgery, robotic cases run longer but have lower conversion rates to open. Pediatric applications remain off-label pending FDA approval, though the platform shows promise for adrenal masses, nephrectomy, polycystic kidneys, chest procedures, pelvic reconstruction, and abdominal tumors; port spacing of 3 cm is recommended in smaller patients. With trained teams, room turnover matches laparoscopy, mitigating upfront time costs. The trajectory suggests robotics will become the dominant minimally invasive modality for the next generation of surgeons.
- Robotic surgery achieves proficiency in half the cases required for laparoscopy (10–15 vs 20–30), with faster reduction in operative times after initial training.[e14985-c3][e14985-c4][e14985-c13][e14985-c14]
- Oncologic outcomes are equivalent between robotic and laparoscopic approaches, with robotics showing lower conversion rates to open in colorectal surgery despite longer operative times.[e14985-c10][e14985-c11][e14985-c15]
- Technical advantages include 7 degrees of freedom, enhanced depth perception, reduced surgeon fatigue, and emerging haptic feedback for suture tension detection.[e14985-c1][e14985-c7][e14985-c8][e14985-c9]
- Pediatric applications remain off-label but show promise for adrenal, renal, thoracic, and pelvic cases; 3-cm port spacing is recommended in smaller patients.[e14985-c5][e14985-c16][e14985-c18][e14985-c19]
- Clinical benefits include reduced postoperative pain, lower infection risk, and faster recovery; trained teams achieve room turnover times comparable to laparoscopy.[e14985-c2][e14985-c6][e14985-c12]
For patients & families
Physicians discussed how robotic surgery is changing the way some operations are performed in children. The robotic instruments can move in more ways than a surgeon's hand alone, which helps with precision . Doctors noted that robotic surgery often leads to less pain and fewer infections after the operation, helping children recover faster . The technology also gives surgeons better depth perception and causes less fatigue during long procedures [e14985-c8, e14985-c9]. While robotic surgery can take longer at first, surgeons become skilled more quickly than with traditional minimally invasive techniques—requiring only 10 to 15 cases to reach basic proficiency compared to 20 to 30 cases for laparoscopy [e14985-c13, e14985-c14]. After gaining experience, robotic procedures become faster [e14985-c4, e14985-c6]. Physicians emphasized that robotic surgery produces results just as good as other approaches for cancer operations [e14985-c11, e14985-c15]. The technology is particularly useful for certain pediatric cases including kidney problems, chest surgeries, and pelvic reconstruction [e14985-c18, e14985-c19]. Currently, the FDA has not yet approved robotic systems specifically for children, though approval is expected . Doctors believe robotic surgery will become the standard approach for future pediatric surgeons .
Physicians discussed how robotic surgery is changing the way some operations are performed in children. The robotic instruments can move in more ways than a surgeon's hand alone, which helps with precision . Doctors noted that robotic surgery often leads to less pain and fewer infections after the operation, helping children recover faster . The technology also gives surgeons better depth perception and causes less fatigue during long procedures [e14985-c8, e14985-c9]. While robotic surgery can take longer at first, surgeons become skilled more quickly than with traditional minimally invasive techniques—requiring only 10 to 15 cases to reach basic proficiency compared to 20 to 30 cases for laparoscopy [e14985-c13, e14985-c14]. After gaining experience, robotic procedures become faster [e14985-c4, e14985-c6]. Physicians emphasized that robotic surgery produces results just as good as other approaches for cancer operations [e14985-c11, e14985-c15]. The technology is particularly useful for certain pediatric cases including kidney problems, chest surgeries, and pelvic reconstruction [e14985-c18, e14985-c19]. Currently, the FDA has not yet approved robotic systems specifically for children, though approval is expected . Doctors believe robotic surgery will become the standard approach for future pediatric surgeons .
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Single incision laparoscopic appendectomy technique and instrumentation
SILS appendectomy requires a specialized 10mm laparoscope with a 5mm working channel and extra long instruments to go down the working channel.
clinicalRosen0:17 ↗
The 10mm scope will only fit through a 12mm trocar.
clinicalRosen1:39 ↗
Cecal mobilization is performed by gently opening the peritoneum overlying the attachment between the cecum and body wall, taking care not to injure structures beneath.
clinicalRosen2:39 ↗
The degree of cecal mobilization varies depending on how mobile the appendix is initially and how thick the abdominal wall is.
clinicalRosen3:18 ↗
If the appendix can come up to the liver laparoscopically, then most likely it will be able to be delivered up through the abdominal wall.
clinicalRosen3:47 ↗
Early in performing SILS appendectomy, it is beneficial to get a good intracorporeal view of the base ligature to ensure adequate ligation flush to the cecum without leaving a segment of appendix.
clinicalRosen6:20 ↗
When deciding between one or three port approach, patient body habitus, duration of illness, and appendix size if imaging was obtained should be factored in.
clinicalRosen7:05 ↗
Obese or extremely muscular patients can have thick abdominal walls that make it difficult to deliver even a mildly inflamed appendix.
clinicalRosen7:14 ↗
The challenge of appendix delivery is compounded when the appendix is very thick and friable.
clinicalRosen7:25 ↗
A five-minute timer approach is reasonable when attempting SILS, and if not making significant progress after 10 minutes, conversion to traditional three-port laparoscopy should be considered.
opinionRosen7:35 ↗
A 12mm trocar placed through the umbilicus by Veress needle technique will make an opening that in thin small patients will be large enough to work through for appendectomy.
clinicalRosen8:12 ↗
When the abdominal wall is thick or the appendix is thick and friable, the fascial opening may need to be enlarged to safely deliver the appendix.
clinicalRosen8:22 ↗
When placing a trocar by open technique, starting with the skin and fascial incision as large as possible while still concealing it within the umbilicus helps avoid failing to deliver the appendix initially.
clinicalRosen8:31 ↗
A large fascial incision can make it hard for the trocar to stay in, which can be addressed by securing the trocar with a towel clip or suture.
clinicalRosen8:49 ↗
If gas is leaking around the trocar, the insufflator flow should be set on high.
clinicalRosen8:57 ↗
The suction irrigator should not be opened in routine SILS appendectomy cases, nor is it necessary if only suction is needed.
clinicalRosen9:05 ↗
For aspirating small amounts of fluid, the suction probe can be inserted through the port with the outside end covered with a lap pad, using thumb pressure to alternately press and relax on the gauze to allow positive pressure from insufflation to push fluid out.
clinicalRosen9:19 ↗
In cases of advanced or perforated appendicitis, the suction irrigator should be opened.
clinicalRosen9:45 ↗
With a thick abdominal wall, placing a small Weitlaner retractor in the wound with downward pressure can help expose the appendiceal base.
clinicalRosen9:50 ↗
When ligating the mesoappendix, flashing and reclamping the mesentery as the tie is cinched down can prevent losing the divided end into the abdomen before the tie is set.
clinicalRosen10:00 ↗
When the appendiceal base is deep in the wound and hard to ligate by usual means, endoloops can be used to get the tie down into position.
clinicalRosen10:16 ↗
If uncertain about ligation at the true appendiceal base, the appendix can be ligated with a long suture held externally, returned to the abdomen for laparoscopic verification, and if inadequate, further dissection can be performed before completing appendectomy.
clinicalRosen10:32 ↗
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
Robotic instruments have 7 degrees of freedom compared to 6 for the human hand.
clinicalJuan Gurria0:41 ↗
Robotic surgery reduces postoperative pain and infection risk, leading to faster recovery.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position1:02 ↗
The learning curve for robotic surgery is better than laparoscopic surgery.
clinicalJuan Gurria1:21 ↗
Time to reduce operative times is way faster for robotic than laparoscopic after a few cases.
clinicalJuan Gurria1:27 ↗
There is currently no FDA approval for robotic surgery in pediatrics, but it should be coming soon.
guidelineJuan Gurria1:42 ↗
After a few cases, robotic surgery decreases operative time, which reduces costs in the long run.
clinicalJuan Gurria1:53 ↗
New robotic systems allow surgeons to detect when suture is about to rupture.
clinicalJuan Gurria2:05 ↗
Robotic surgery improves depth perception compared to laparoscopic surgery.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:09 ↗
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