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Pediatric Urological Surgeries

Robotic surgery is still in its evolving stage in the management of urological conditions in pediatric patients. The reasons for these are many, including the unavailability of instruments specific to children. However, certain procedures, such as pyeloplasty, can be effectively performed through robotic surgery. Further, the application of robotics in pediatric urological surgeries is also witnessed in nephrectomy, bladder augmentation, and ureteral reimplantation.

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  • Pyeloplasty: The procedure involves the removal of a blockage at the ureteropelvic junction that prevents urine from flowing from the kidney to the bladder. Robotic pyeloplasty has become the standard of treatment for small and older children. Studies reported significant improvement in hydronephrosis through robotic surgery.
  • Partial Nephrectomy and Nephroureterectomy: Partial nephrectomy can be performed through robotic arms for benign conditions, such as multicystic dysplastic kidneys, atrophic kidneys, and renovascular hypertension. Robotic surgery is also useful in performing bilateral procedures, such as nephrectomy with contralateral reimplantation of the ureter.
  • Ureteroureterostomy: Normally, each kidney is connected to the bladder through a single ureter. However, in some cases, one or both kidneys have two ureters. Ureteroureterostomy is the procedure in which the surgeon connects both ureters originating from a single kidney to make a Y-shaped drain into the bladder.
  • Ureteral Reimplantation: Robotic-assisted laparoscopic ureteroneocystostomy is performed to treat vesicoureteral reflux disease. Studies have reported that the robotic extravesical approach results in lower analgesic requirements and a reduced hospital stay compared to open intravesical reimplantation.
  • Bladder Diverticulectomy: Bladder diverticula may occur due to neuropathic bladder dysfunction, bladder outlet obstruction, or congenital defects. It leads to an increased risk of urinary incontinence and infection. Robotic surgery may be safely performed to remove the bladder diverticula.
  • Mitrofanoff Procedure: This procedure, also known as appedicovesicostomy,is a procedure involving creating a tube in the abdomen of the child that helps with urination through the catheter. The new tube is formed from the appendix. The surgeon connects the bladder to the belly button or makes a new hole in the lower abdomen.
  • Bladder Augmentation: Bladder augmentation is a procedure that involves increasing the size of the bladder and improving its stretching ability to allow it to hold more urine. The procedure is also known as cystoplasty. Cystoplasty is successfully performed through robotic surgery.