Recent Developments in the Use of Robotic Technology in Pediatric Urology

Abstract

Robotic surgery affords refined surgical movements that exceed the natural range of motion of the human hand, combined with high definition three-dimensional visualization and superior magnification. While open surgery has long been the standard of care in the pediatric population, robot-assisted surgery (RAS) has gained increasing acceptance among pediatric urologists, bridging the gap between laparoscopy and open surgery. Pyeloplasty for ureteropelvic junction obstruction remains the most commonly performed robotic procedure in pediatric urology; however, utilization of RAS has expanded to include nearly all upper and lower urinary tract surgeries in the pediatric urologist’s armamentarium. Ongoing innovation has led to improved methods and instrumentation, facilitating ease of patient recovery and improved quality of life outcomes.

Keywords:

• Robotics
• Laparoscopy
• Minimally invasive surgery
• Pediatrics
• Urology

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Knowledge of the available instrumentation and robotic platform is critical for successful surgical outcomes.

• Robotic surgery has gained widespread acceptance, because of multiple advantages including quicker postoperative recovery, fewer analgesic requirements, shorter length of hospital stay and superior cosmetic outcomes.

• Pyeloplasty is the most commonly reported robotic procedure in the pediatric population, and is technically feasible and safe in children, including infants.

• Robot-assisted heminephrectomy allows for precise dissection of the affected moiety followed by reconstruction. Simple nephrectomy does not require complex laparoscopic skills (i.e. intracorporeal suturing), thus the benefit of robotic technology is less clear.

• Robotic ureteral reimplantation can be used to treat both VUR and distal ureteral obstruction with success rates comparable to open repairs.

• Robot-assisted procedures must prove that the perceived benefits of improved cosmesis and decreased analgesia are not at the expense of patient safety or efficacy.