Robot-assisted bladder diverticulectomy in a 9-year-old boy

Abstract

Bladder diverticulum in children is rarely encountered in the practice of a pediatric urologist. If the bladder diverticulum has clinical manifestations (pain, urinary tract infection, hematuria, voiding dysfunction, vesicoureteral reflux, or obstruction of the ureterovesical anastomosis), then surgical treatment is indicated. Recently, more and more publications began to appear on the removal of the bladder diverticulum using laparoscopic or vesicoscopic access. Several foreign publications report on the removal of a bladder diverticulum in children using a robotic approach.
 A 9-year-old boy with a diagnosis of bladder diverticulum underwent surgical intervention in the volume of robot-assisted bladder diverticulectomy in January 2020 at the Almazov National Medical Research Centre. Ports da Vinci 12 and two 8 mm were used, as well as an assistant 5 mm port, which were installed in typical places for lower abdominal surgery. The duration of the operation was 135 minutes. Console time - 75 minutes. The volume of blood loss is 20 ml. The patient was in the intensive care unit for a day. The urethral catheter was removed on the 7th day after the operation. Urination independent, free; phenomena of delay, incontinence were not noted. The patient was discharged on the 9th postoperative day in a satisfactory condition. At the control examination after a year at the place of residence, she does not complain, urination is not disturbed, there are no pathological changes in the ultrasound of the kidneys and bladder.
 Robot-assisted bladder diverticulectomy in children is a feasible, effective and safe treatment option in expert centers with extensive experience in robotic surgery. The described clinical case of bladder diverticulectomy is the first in Russia performed using a robotic system in pediatric practice.

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“…В то же время авторы обращают внимание на ограничения для выполнения таких операций у новорожденных и младенцев ввиду размеров применяемых инструментов. В то время как у более старших детей такие операции проводятся, примером чего может служить оперативное робот-ассистированное вмешательство по поводу дивертикулэктомии мочевого пузыря с использованем системы Da Vinci с ассистентским 5 мм портом [52]. В этой системе имеются также и инструменты размером 3 мм [53].…”