Expanding the limits of robotic surgery in children: First report of robotic assisted ligation of persistent superior vena cava.

Vecchione S.; Matcovici M.; VanDoorn C.; Alizai N.

Expanding the limits of robotic surgery in children: First report of robotic assisted ligation of persistent superior vena cava.

All Authors

Vecchione S.

Matcovici M.

VanDoorn C.

Alizai N.

LTHT Author

Vecchione, Sarah
Matcovici, Melania
Van Doorn, Carin
Alizai, Naved

LTHT Department

Leeds Children's Hospital
Paediatric Surgery
Congenital Cardiac Services

Publication Date

2025

Item Type

Conference Abstract

Subject

PAEDIATRICS , ROBOTIC SURGICAL PROCEDURES , CONGENITAL ABNORMALITIES , CARDIAC SURGICAL PROCEDURES , CARDIOVASCULAR ABNORMALITIES

Abstract

Aims: Embryological failure of regression of anterior cardinal vein is a rare vascular anomaly causing Persistent Left Superior Vena Cava (PLSVC). Drainage into left atrium (LA) causes significant right to left shunt with resultant cyanosis. In the presence of an adequate right SVC, occlusion of PLSVC abolishes the cyanosis. There are no reports of robotic-assisted closure of PLSVC in children or adults. We describe the first case of this kind. Method(s): Patient's records were reviewed. Literature search of MEDLINE, Web of science and CENTRAL was performed. Result(s): We present a 4 yr old girl with antenatally diagnosed PLSVC and significant cyanosis. Imaging demonstrated a small bridging vein between left and right SVC and hemiazygos draining into PLSVC. The PLSVC was over 1 cm wide and required occlusion at short length segment between the entrance of hemiazygous and LA. Percutaneous attempt failed and following multidisciplinary discussion, minimal access approach was decided to avoid sternotomy/ lateral thoracotomy as these can have considerable sequelae. 3D model reconstruction helped the pre-operative planning. Patient underwent robotic clipping of PLSVC via left chest with immediate resolution of cyanosis and normalised oxygen saturation. There were no complications and she was discharged on day one post-operative. On follow up, she is fully saturated with normal ECHO. Conclusion(s): To the authors best knowledge, this represents the first case report of robotic closure of PLSVC. This case demonstrates the feasibility and the dexterity advantages with excellent outcomes. It underlines the versatility of the robotic approach in a wide range of pathologies.