An efficient laparoendoscopic technique for bilateral intravesical ureteral reimplantation would offer the certainty of cure provided by open surgery with the reduced morbidity of laparoscopy. We have assessed the clinical utility of robotically assisted intravesical bilateral ureteral reimplantation in children. Ports are placed in the dome of the bladder, and the procedure is performed in a fashion identical to that used for open transtrigonal reimplantation. A catheter is left in place for 1 or 2 days. With modifications in port placement using the VersaStep radially dilating sheath system, we have not had any port-site leakage. One patient has unilateral persisting low-grade reflux. This technique may be a useful option for antireflux surgery and should be further refined.
Although the laparoscopic approach to the treatment of complex biliary disease is possible, it is technically challenging. In an attempt to overcome these difficulties, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, California) was used to facilitate the minimally invasive treatment of a type I choledochal cyst in a 5-year-old, 22 kg, girl. Complete resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy were performed using the robotic surgical system. Total robotic setup time (preparation, port placement, docking) was 40 minutes. Total procedure time was 440 minutes. Total robotic operative time was 390 minutes. No intraoperative complications or technical problems were encountered. At 6-month follow-up, the child is doing well with no episodes of cholangitis. Robot-assisted laparoscopic type I choledochal cyst resection appears safe and feasible. The three-dimensional visualization and wristed instrumentation greatly aids in the dissection of the cyst and in the biliary reconstruction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.