Robotic Urologic Surgery in Infants: Results and Complications

Abstract

Over the last 30 years, robotic surgery has evolved into the preferred surgical approach for many operative cases. Robotics has been associated with lower pain scales, shorter hospitalizations, and improved cosmesis ( 1 , 2 ). However, its acceptance in pediatrics have been hampered by longer operative times, smaller working space, and limited fine surgical instruments. Many find these challenges even more pronounced when performing robotic surgery in infants (i.e., children <1 year old). Although the data in infants is less robust, many studies have shown benefits similar to the adult population. Specifically, multiple reports of robotic surgery in infants have shown lower postoperative analgesic use. Additionally, hospital stays are shorter, which may lead to quicker return to work for parents and guardians. Multiple reports have shown low complication rates of robotic surgery in infants. When complications have occurred, they are usually Clavien Grade 1 and 2, with occasional grade 3. Often the complications are not from the robotic technique, but are linked to other factors such as the ureteral stents ( 3 , 4 ). Most importantly, the success rates of surgery are comparable to open surgery. This chapter will review indications for the most common urologic robotic surgeries performed in infants. Also, we will review reported results and complications of robotic surgery in children, with specific attention to the infant population. However, data focused only on infants is limited. Many studies have some infant patients, but their results are often mixed with all pediatric patients.

Robotically Assisted Surgery in Children—A Perspective

“…These selection criteria were chosen because RAS is technically more challenging in newborns and infants (age < 1 year; weight < 10 kg). The smaller working space increases the risk of complications, such as robotic arm collisions or suboptimal trocar placement [ 6 , 12 ]. Additionally, the conclusions (e.g., on safety) that have been reported in the data published for this subgroup are sparse [ 6 , 13 ].…”

“…The smaller working space increases the risk of complications, such as robotic arm collisions or suboptimal trocar placement [ 6 , 12 ]. Additionally, the conclusions (e.g., on safety) that have been reported in the data published for this subgroup are sparse [ 6 , 13 ]. It was required that the reported surgery be abdominal or thoracic.…”

“…As early as 2004, Woo and colleagues, in their review, had already indicated the potential of RAS for pediatric surgery [ 5 ]. Given children’s smaller anatomical structures, it has been suggested that the advantages of RAS include tremor filtration ability and a greater range of motion [ 6 , 7 , 8 , 9 ]. Additionally, technologies such as eye-tracking cameras and three-dimensional visualization are now available for optimal spatial vision and precise handling.…”

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

“…Due to the high cost of RAS, it has been applied mainly in complex pediatric reconstructive procedures such as pyeloplasty, fundoplication, ureteral reimplantation and choledochus cyst removal, and less frequently in simpler procedures such as varicocelectomy or appendicectomy [6][7][8][9][10]16]. Robotic operating rooms (ORs) are often shared by several specialties, including adult surgery, and therefore may be located outside of pediatric hospitals or departments [6].…”

The Role of the Versius Surgical Robotic System in the Paediatric Population

“…Amongst paediatric disciplines, urology is the subspecialty in which robot-assisted surgery is most utilised. General advantages have been shown to be reduced post-operative pain and analgesia requirements, shorter hospital stays, and improved cosmesis compared with open surgery [ 3 , 42 , 43 ]. The most commonly performed robot-assisted procedure in children is the pyeloplasty.…”