Laparoscopic and robotic pediatric surgery Hillary Copp and Craig A Peters

Abstract

Over 25 years have passed since Silber and Cohen first reported the application of laparoscopic surgery in pediatric urology for cryptorchidism.1 Initially the practice of pediatric laparoscopic surgery was devoted to diagnostic procedures including the evaluation of cryptorchidism and intersex conditions. Over time the field has evolved to encompass extirpative surgeries, such as total and partial nephrectomy, and finally reconstructive operations, like pyeloplasty and ureteral reimplantation. While pediatric urologic laparoscopy is routinely performed at some academic centers, it has not become common practice because it demands a high level of technical skill, requiring significant investment of time to develop. With the advent of robotic technology the possibility for laparoscopy to become more widespread in the pediatric urologic community exists since robotic assistance may be able to facilitate the acquisition and maintenance of laparoscopic skills by the surgeon. It may assist the diagnostic laparoscopic surgeon in the transition to operative laparoscopy. Moreover, for the physician adept in laparoscopic surgery, the robot may be beneficial for the more complex and technically demanding reconstructive surgeries. In this chapter, we address general aspects of laparoscopic and robotic surgery as applied to the pediatric urologic patient and the specific laparoscopic and robotic approaches currently in practice.