Robot-assisted urologic surgery: safety and feasibility in the pediatric population

To assess the safety and feasibility of performing robot-assisted pediatric urologic surgery with the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, Calif) based on our experience with a variety of procedures.

A retrospective review was performed of 53 robot-assisted pediatric procedures performed in our practice between September 2003 and March 2006. The procedures included 11 renal extirpative surgeries, 10 orchiopexies, 26 dismembered pyeloplasties, 2 uretero-ureterostomies, and 3 bladder surgeries. The mean patient age was 7.7 years, and the mean patient weight was 32 kg. All procedures were performed transperitoneally.

All procedures were successfully completed with no conversions to open surgery. There was one procedure in which the robotic system malfunctioned, resulting in an unrecoverable loss of three-dimensional visualization and temporary loss of color. The only postoperative complication involved delayed return of bowel function that led to a diagnostic laparotomy with negative findings. A decrease in mean postoperative stay was noted in patients who underwent robot-assisted procedures compared with previous patients who had undergone open surgery.

Robot-assisted surgery appears to be safe and feasible for a variety of pediatric urologic procedures. Prospective randomized studies are required to further evaluate the outcomes compared with open surgical procedures. Our initial experience has been encouraging and will serve as a foundation for future and more complex minimally invasive pediatric urologic operations.