Robotic surgery in pediatric urology: Current status

Abstract

Robot‐assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3‐D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

“…Pediatric urology is one of the most common and useful fields of application of robotic technology, as confirmed in different studies. 9,13,19 RALP is currently the most frequent procedure performed in the pediatric population, and the only one where outcomes have been proved to be at least comparable to the open or laparoscopic techniques. 11,12,20 Many other applications of RAS, including ureteral reimplantation, appendico-vesicostomy creation, bladder neck reconstruction, and kidney stone surgery, have been described in children but further evidence is needed to validate these indications.…”

“…11,12,20 Many other applications of RAS, including ureteral reimplantation, appendico-vesicostomy creation, bladder neck reconstruction, and kidney stone surgery, have been described in children but further evidence is needed to validate these indications. 8,9,13,21 Despite all the reported advantages, there are still several limitations to a large-scale application of RAS in pediatric population, as demonstrated by lack of large case series and comparative studies between RAS and traditional approaches. The first limitation is represented by low-weight children and infants.…”

“…8,9 Many other applications of RAS, including ureteral reimplantation, appendico-vesicostomy creation, bladder neck reconstruction, and kidney stone surgery, have been described in children but further evidence is needed to validate these indications. 8,9,13 The aim of this multicentric survey was to give an overview about the diffusion of pediatric RAS in Italy, to show how the training period is structured in Italy and to assess the main indications and the preliminary outcomes of RAS in pediatric patients. Additionally, we aimed to outline the main limitations for a widespread diffusion of RAS in pediatric patients.…”

Pediatric Robotic Surgery in South America: Advantages and Difficulties in Program Implementation

“…The relatively high incidence of ureteropelvic junction obstruction combined with surgeon familiarity with laparoscopic pyeloplasty made it a natural first robotic procedure. Since then, it has become more commonly performed accounting for 11–12.6% of pyeloplasties performed in the USA by 2009 (4), and it accounts for about 40% of cases nowadays (5–7).…”

“…Ureteral reimplantation, both intra or extravesical approach, robotic assisted ureteroureterostomy for the treatment of ectopic ureter and ureterocele have become more frequently performed according to recent publications. On the other hand there are an increasing number of reports of complex reconstructive procedures, such as urinary incontinence treatment with procedures on the bladder neck, bladder augmentation, and continent urinary stoma (5, 8, 9).…”