Current Status of Robotic Surgery in Pediatric Urology

Andolfi, Ciro; Kumar, Rana; Boysen, William R.; Gundeti, Mohan S.

doi:10.1089/lap.2018.0745

Cited by 43 publications

(35 citation statements)

References 75 publications

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“…6,7 Despite all these technical advantages of robot, its largescale application has still several limitations in children. 8,9 The largest barrier is represented by the significant cost of acquiring and maintaining the da Vinci robot. Another important challenge is to adapt the big robotic platform, originally designed for adults, to the small dimensions of children.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 The most important limitation is still represented by the costs, which remain higher than the open approach. 8,9 Many other applications of RAS, including ureteral reimplantation, appendico-vesicostomy creation, bladder neck reconstruction, and kidney stone surgery, have been described in children but further evidence is needed to validate these indications. 8,9,13 The aim of this multicentric survey was to give an overview about the diffusion of pediatric RAS in Italy, to show how the training period is structured in Italy and to assess the main indications and the preliminary outcomes of RAS in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

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Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Esposito

Masieri

Castagnetti

et al. 2023

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Pediatric robot-assisted surgery (RAS) is gaining increasing acceptance. We aimed to assess the diffusion of pediatric RAS in Italy, the training period, indications, preliminary outcomes, and limitations. Materials and Methods: An online questionnaire-based survey was performed. The data about robotic activity of 9 Italian Pediatric Surgery units were collected and analyzed. Results: Most of the participating centers (7/9, 77.8%) started RAS less than 5 years ago with only 2 centers (22.2%) performing RAS since 2010. The training included dry-lab in 5/9 centers (55.5%), wet-lab in 5/9 centers (55.5%), and robot simulator in 7/9 centers (77.8%), followed by an exam to obtain a certificate. The average duration of training was 23.7 hours (range 5-50). A total of 209 robotic procedures was performed in all centers during the period 2010-2018 and included 119 urological (56.9%), 31 gynecological (14.8%), 41 gastrointestinal (19.6%), 12 oncological (5.7%), and 6 other (2.8%) procedures. The docking time significantly fell down after 18 robotic procedures (P = .001). Intraoperative complications were recorded in 4 cases (1.9%). Conversion to laparoscopy was needed in 4 cases (1.9%) whereas conversion to open was required in 6 cases (2.8%). Postoperative complications occurred in 17/209 cases (8.1%) and were graded Clavien I-II in 14 cases (6.7%) and Clavien IIIb in only 4 cases (1.9%). Conclusions: Our study confirmed that RAS has still a limited diffusion in Italy for pediatric patients. Before starting robotic activity, pediatric surgeons have to obtain a certificate after a virtual and experimental training period. A mentorship clinical period of 10 cases under supervision of a proctor is also needed. The main indications in children remain reconstructive urological procedures. RAS is safe in children but its applications are currently limited to patients older than 2 years and with a weight >15 kg, due to the size of robotic ports.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Esposito

Masieri

Castagnetti

et al. 2023

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

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“…RAS in paediatric departments is proliferating globally [1,4]. With its superior, magnified three-dimensional view, articulated instruments, tremor eradication and improved ergonomics, RAS is unlikely to disappear from the operative canon.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of robot-assisted surgery (RAS) have been widely documented [1][2][3], with joint articulation allowing enhanced freedom of movement, providing greater accuracy and simplifying complex manoeuvres. The benefits for the operating surgeon are potentially longer lasting, as it is ergonomically superior to laparoscopic surgery and reduces fatigue.…”

Section: Introductionmentioning

confidence: 99%

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Urology robotic journey: demonstrating the learning curve in robot-assisted pyeloplasties (RALP)

et al. 2019

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Introduction The advantages of robot-assisted pyeloplasties (RALP) have been widely documented and increasingly familiar. A 'learning curve' (LC) is difficult to define and its objective review remains problematic. We aimed to evaluate the LC, and outcomes, of RALP performed at our newly established robotic centre. Method and materials After the appropriate training, robot-assisted surgery (RAS) commenced at our centre. A prospective database was maintained regarding demographics and intra-operative timings of all cases, post-operative stay and complications. The data were statistically interrogated and linear regression analysis was performed. Results Between April 2014 and September 2018, 29 urological RAS were performed including 23 RALP. The total operating and total console times were significantly decreased over time, with no significant differences seen in length of stay or complication rates. Regression analysis predicted achievement of open pyeloplasty time (148 min) at 26 cases and 'expert' console time (58 min) by case 34. Median length of stay was 2 days and operative success rate 96%. Discussion RAS is proliferating across the globe. LC is difficult to define objectively. We suggest that the points described here in this 'learning journey' can be applied to other nascent departments and that RALP is safe and feasible within a developing urology unit.

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