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  • Review Article
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Robot-assisted laparoscopic urological surgery in children

Nature Reviews Urology volume 10, pages 632–639 (2013)Cite this article

Subjects

Abstract

Robot-assisted laparoscopic surgery (RALS) has been proven to be safe and effective for various urological procedures in children, including pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation. The robot system enables delicate and precise movements, which are ideal for the types of reconstructive surgeries that children with urological issues often require, overcoming many of the impediments associated with the conventional laparoscopic approach. RALS helps the relative novice to perform fine surgical techniques and is thought to reduce the learning curve associated with some surgical techniques, such as intracorporeal suturing, owing to the improved freedom of movement of the surgical instruments, the ergonomic positioning of the surgeon, and the 3D vision provided by the robotic system. Given the favourable safety profile and associated benefits of the robot system, including reductions in mean postoperative hospital stay compared with conventional procedures, RALS is becoming more widely adopted by paediatric urologists.

Key Points

  • Robot-assisted laparoscopic surgery (RALS) is safe and effective in the surgical management of various paediatric urological conditions

  • The advantages of RALS include shorter hospitalization times, quicker recovery, and ease of surgery; the disadvantages include longer operative time and increased material cost

  • Special anaesthesia considerations—for example, CO2 absorption and the effect of the pneumoperitoneum on ventilation—should be made when performing RALS in young or small children

  • Modifications to robotic positioning and port placement should be considered when performing RALS in the paediatric population owing to limitations in body surface area and intra-abdominal space

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Figure 1: Robot-assisted laparoscopic right pyeloplasty was performed in a 15-year-old boy with a ureteropelvic junction obstruction.
Figure 2: Robot-assisted laparoscopic bilateral extravesical ureteral reimplantation was performed in a 6-year-old girl with bilateral grade 4 vesicoureteral reflux.
Figure 3: Robot-assisted laparoscopic bilateral intravesical ureteral reimplantation was performed in a 10-year-old girl with bilateral grade 4–5 vesicoureteral reflux.
Figure 4: Robot-assisted laparoscopic upper to lower pole ureteroureterostomy was performed in a 7-year-old girl with an ectopic left upper pole ureter and an associated functional renal moiety.
Figure 5: Robot-assisted laparoscopic left upper pole heminephrectomy was performed in a 4-year-old girl with a left ectopic obstructed upper pole ureter and an associated nonfunctioning renal moiety.
Figure 6: Robot-assisted laparoscopic creation of a continent catheterizable conduit (Mitrofanoff) was performed in a 10-year-old boy with a neurogenic bladder secondary to myelomeningocele.

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Author information

Authors and Affiliations

  1. Department of Urology, The Robotic Surgery, Research and Training Centre, Boston Children's Hospital, 300 Longwood Avenue, Boston, 02115, MA, USA

    Luís F. Sávio & Hiep T. Nguyen

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  1. Luís F. Sávio
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Contributions

L. F. Sávio researched the literature for this Review. Both authors contributed towards writing the article. H. T. Nguyen discussed the content with colleagues and reviewed the article prior to submission.

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Correspondence to Hiep T. Nguyen.

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The authors declare no competing financial interests.

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Sávio, L., Nguyen, H. Robot-assisted laparoscopic urological surgery in children. Nat Rev Urol 10, 632–639 (2013). https://doi.org/10.1038/nrurol.2013.220

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