Abstract
The evolution of robotic surgical technology and its application in Pediatric Urology have been rapid and essentially successful. Further development remains limited in three key areas: procedural inefficiencies, cost and integration of surgical and clinical information. By addressing these challenges through technology and novel surgical paradigms, the real potential of surgical robotics in pediatric, as well as adult applications, may ultimately be realized. With this evolution, a continued focus on patient-centered outcomes will be essential to provide optimal guidance to technical innovations.
Highlights
Robot assisted surgical systems have revolutionized minimally invasive surgery, providing many advancements, including three-dimensional visualization, elimination of surgeon tremor, wristed instruments, and improved surgeon ergonomics
Since the first Intuitive Surgical da Vinci R surgical system was approved by the Food and Drug Administration in 2000, robot assisted surgery has been embraced by surgeons worldwide
The initial application of robot assisted surgery in the field of urology began with adult robot assisted prostatectomies and was soon applied to the pediatric population with robot assisted pyeloplasties [2]
Summary
Robot assisted surgical systems have revolutionized minimally invasive surgery, providing many advancements, including three-dimensional visualization, elimination of surgeon tremor, wristed instruments, and improved surgeon ergonomics. As the most common robot assisted surgery performed in children, robot assisted pyeloplasty has a more robust literature compared to that of other procedures; published studies are case series and not randomized controlled trials [12]. These different studies used different criteria of outcomes such as resolution of pain, decrease in hydronephrosis. In order to truly assess patient outcomes, such as disease resolution, pain, and recovery, as well as compare results to that of open procedures, it is paramount for future research to clearly delineate all potential factors that can affect outcomes in order to accurately evaluate the efficacy of robot assisted pediatric urological surgery. While outcomes have been shown to be similar with the HIDES trocar placement, we recommend for surgeons especially at the beginning of their learning curve to use trocar placement locations that decrease the level of procedural difficulty [19]
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