Iris Publishers- Open access journal of Urology & Nephrology | Robotic Pyeloplasty in Infants: A Review of Safety and Outcomes

 

 

Authored by Christina Kim

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. 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 surgeryWhen robotic surgery was introduced, there was excitement due to three-dimensional imaging, 10-fold camera magnification, tremor filtering, and new camera control by the surgeon. Also, there is instrument articulation with full range of motion. Surgeons hoped these enhancements would allow precise suturing, improve tissue handling, and increase ease of doing complex surgical cases.
A wide variety of robotic procedures have been described in children. However, reported outcomes in children (particularly in infants) are limited. To date, pyeloplasty is the primary pediatric robotic surgery with comparable safety and efficacy when compared to open or standard laparoscopic approach. This has been supported by large multi-centric studies [5]. Also, this has been supported by the European Association of Urology Pediatric guidelines. The guidelines recognize the benefits of minimally invasive surgery by stating that “in experienced hands, laparoscopic or retroperitoneoscopic techniques and robot-assisted techniques have the same success rates as standard open procedures.” Also, they state that “Robotic-assisted laparoscopic pyeloplasty has all the same advantages as laparoscopic pyeloplasty plus better maneuverability, improved vision, ease in suturing and increased ergonomics but higher costs”. However, the role for robotic pyeloplasty in infants is less supported when the EUA states “There does not seem to be any clear benefit of minimal invasive procedures in a very young child, but current data is insufficient to defer a cut-off age.

To read more about this article...Open access neurology journals

Please follow the URL to access more information about this article
https://irispublishers.com/aun/fulltext/robotic-pyeloplasty-in-infants-a-review-of-safety-and-outcomes.ID.000509.php 

To view more about our journals...Iris Publishers