Robotic augmentation ileocystoplasty with bilateral ureteric reimplantation in a young child with neuropathic bladder

An Audit of Robot-Assisted Minimally Invasive Surgeries in Children: Early Experience from a Tertiary Care Center in India

Background: Over the last decade, a significant rise in pediatric robot-assisted minimally invasive surgeries has been observed. Apart from the urological surgeries in children, robot assistance for complex nonurological reconstructions is being explored increasingly. This study highlights our preliminary experience of robot-assisted minimally invasive surgeries in children. Materials and Methods: An ethical waiver was given by the Institute's Ethics Committee in view of the retrospective nature of the study and all procedures being performed as a part of the routine care. A retrospective analysis was done to include all the pediatric robot-assisted surgeries performed at our hospital over a 4-year period (January 2017-January 2021). The surgeries were categorized based on the involved organ system and the total study duration was divided into four 12-month time periods. A comparison of the total number of surgeries done in each time period was also done. A log of the surgeon's console duration for each surgery was also kept. Results: A total of 65 patients, with the majority (50/65; 77%) undergoing reconstructive surgeries for anomalies within the genitourinary system, were included. Almost two-thirds of the total surgeries were technically complex. The number of procedures performed during the four 12-month time periods was 18, 18, 15, and 14. The average (range) surgeon's console time was 95 minutes (45-327 minutes) and showed a progressive improvement with the passage of time. Only 1 patient required conversion to an open approach, and none had major complications during the postoperative period. Conclusion: Our early experience of robot-assisted minimally invasive surgeries in children reaffirms its safety and feasibility in complex reconstructive surgeries. It also highlights the advantages of robot assistance in smaller children with nonurological anomalies.

Robotic surgery in pediatric urology

While robotic surgery has shown clear utility and advantages in the adult population, its role in pediatrics remains controversial. Pediatric-sized robotic instruments and equipment are not readily available yet, so certain modifications can be made in order to make robotic surgery successful in children. While the cost of robotic surgery remains high compared to open procedures, patients experience greater satisfaction and quality of life with robotic surgery. Robotic pyeloplasty is a standard of care in older children, and has even been performed in infants and re-do surgery. Other robotic procedures performed in children include heminephroureterectomy, ureteroureterostomy, ureteral reimplantation, urachal cyst excision, bladder diverticulectomy, and bladder reconstructive procedures such as augmentation, appendicovesicostomy, antegrade continence enema, bladder neck reconstruction and sling, as well as other procedures. Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection. Future improvements in technology with production of pediatric-sized robotic instruments, along with increases in robotic-trained pediatric urologists and surgeon experience along each's learning curve, will help to further advance the field of robotic surgery in pediatric urology.