Robot-assisted minimal invasive pediatric urology

Abstract

Purpose Robot-assisted minimal invasive techniques are well established in adult urology, therefore, we have introduced this technique in children with the support and assistance of our adult urology team. Material and Methods Since May 2007 11 children (age 6-14 y) were operated laparoscopically with the DaVinci® robotic system. We performed 8 pyeloplasties (6 left sided, 2 right sided, 1 reoperation), 2 appendicovesicostomies (+ a bladder neck sling in 1 case) and 1 bilateral extravesical antirefluxplasty. In patients with UPJ obstruction, the indwelling double J catheter was removed 6-8 weeks postop, followed by an ultrasound one month later and a MAG-3 scintigraphy 6 months postop. Results Ten operations were successfully performed. The planned appendicostomy with bladder neck sling had to be converted because of technical difficulties. Total OR time was between 170 – 285 min. Installation time was between 20-30 min in all cases. All children had an uneventful postoperative course. Ultrasound after double J stent removal showed no signs of obstruction. Postoperative MAG-3 showed stable renal function and good drainage in all patients so far. The patient with VUR (grade IV bilat) had normal bladder function postop. Clinically all patients are well. One patient with the Mitrofanoff is on regular CIC, the other has her stoma still stented (2 weeks postop). Conclusions Robot-assisted minimal invasive surgery can be safely and successfully introduced in pediatric urology. The support of a team of adult urologists with a large experience on the DaVinci® system not only helps to reduce the setup and total OR time but can be regarded as a critical factor of success when introducing this new technique in children.