Robotic Assisted Surgery in Pediatric Urology

Robotic assistance may permit more generalized development of laparoscopic reconstruction in pediatric urological procedures such as pyeloplasty and anti-reflux surgery. The relatively slow adaptation of laparoscopic techniques in reconstructive pediatric urology appears to be due to the challenges of efficient and accurate laparoscopic suturing. This review summarizes the current robotic options available for pediatric urological applications, the means of utilization, and early experience. The most commonly available robotic system is the daVinci® (Intuitive Surgical, Mountain View, California) with its EndoWrist technology that permits highly accurate and precise manipulation for laparoscopic dissection, tissue handling, and suturing. The system is large and costly in its current version, but has demonstrated its efficiency and potential in a wide variety of adult applications and now with pediatric uses. Most procedures performed have been transperitoneal, due to the large size of the instruments (12-mm camera port and two 8-mm working ports) and have included pyeloplasty, pyelolithotomy, extravesical anti-reflux procedures, and continent catheterizable stoma using appendix (Mitrofanoff). These procedures have largely been identical to those performed using conventional laparoscopy, and newer procedures will need to develop unique algorithms to take full advantage of the robotic system. Potential applications are numerous and this development is likely to contribute significantly to minimally invasive pediatric urology.