Robotic upper tract surgery in infants 6months or less: is there enough space?

Abstract

Robot-assisted laparoscopic surgery (RALS) has recently been described in children < 1year old. However, little data exist on robotic utilization in infants ≤ 6months old, likely due to concerns for limited intraabdominal space and decreased distance between ports in this cohort. We hypothesized that the robotic approach can be successfully used for infants ≤ 6months old. A prospectively collected database of patients undergoing urologic robotic surgery at our institution was reviewed. Patients ≤ 6months and ≥ 4kg were included. Patient demographics, intraoperative details, hospital length of stay, and complications were reviewed. Descriptive statistics were performed. Twelve patients ≤ 6months old underwent urologic robotic surgery by three surgeons at our institution (2013-2019): pyeloplasty (6), ureteroureterostomy (4), heminephrectomy (1), and nephrectomy (1). Median age at surgery was 4.75months (IQR 4, 6). Median weight was 7.09kg (IQR 6.33, 7.78). Median console time was 105min (IQR 86, 123). For all procedures, 8-mm robotic arm ports were used. No procedures were converted to open. Median post-operative hospital stay was 24h (IQR). Febrile UTI was the only complication occurring within 30days of surgery (n = 4, 33%; 7-20days, Clavien grade 2). For those undergoing pyeloplasty or ureteroureterostomy (n = 10), postoperative ultrasound showed improved (n = 9) or stable hydronephrosis (n = 1). At a median follow-up of 19.73months (IQR 4.27, 38.32), no patient required an unplanned secondary intervention. Robotic upper urinary tract surgery is feasible and safe in patients ≤ 6months of age and can be performed successfully with the same technique as for older children.