Robotic Surgery of the Kidney and Ureter in the Pediatric Population

Abstract

Background: Applications for robotic surgery in pediatric urology have expanded over the past few years. The improved dexterity over laparoscopy and enhanced visualization has made formerly challenging laparoscopic surgical reconstructions possible with the robot. Surgery on the kidney and ureters remains the most commonly performed robotic procedure in pediatric urology and various off-the-shelf techniques have been employed to avoid additional assist ports and invasive imaging.

Highlighted Procedures: At the top of the list of robotic renal surgeries is the ureteropelvic junction repair or pyeloplasty. This procedure has the highest likelihood of replacing the open pyeloplasty as the new gold standard in pediatric urology. Additional renal surgeries such as hemi/partial nephrectomies, ureteroureterostomies, ureteropyelostomies, pyelolithotomies, and total nephrectomies have all been performed well robotically. Most of these procedures require intracorporeal suturing, which is vastly facilitated by the robot.

Another common procedure performed in children is the repair for urinary reflux disease. Both extravesical and intravesical ureteral reimplantations are described and early data suggest that success rates equal if not exceed open success rates.

Future Directions: Some iteration of robotic surgery will become the mainstay of most endoscopic and even open surgery in the next decade. We anticipate that the rapid adoption of robotic surgery in adult urology residencies will facilitate advanced applications in pediatric urology as these current trainees go on to pediatric careers.