Effective intracorporeal space in robot-assisted multiquadrant surgery in a pediatric inanimate model

Pediatric robot-assisted surgery is technically challenging, but it is becoming the most desirable approach for most of the pediatric urological abdominal surgical procedures. Distance between ports has been adopted based on adult surgery experience. Currently, there is scarce information and literature about effective trocar position and distance between ports for highly complex pediatric multiquadrant surgery. The aim of this study is to evaluate the most effective way of port placement for pediatric multiquadrant robot-assisted surgery using an inanimate model. Two inanimate models simulating the abdominal area of an older infant were created: model (1) 33.3 × 29.6 × 11.5 cm and model (2) 15 × 13 × 8 cm. A simulation of a robot-assisted laparoscopic Mitrofanoff procedure was performed in both models simulating appendix procurement and subsequent anastomosis to the bladder dome. In the first model, the simulation was performed in two ways: (a) adult trocars were placed with a distance of 4 cm between them and placed longitudinally and (b) ports were placed by triangulating the camera 2 cm in a cephalic fashion. In the second model, (a) scenario was used as described above (c) single port crossing the arms. Volume of the first model was 11,335.32 cm³. Simulation (b) reached higher percentage of volumes without arm clash (30.19 vs. 41.92%, p = 0.021). In the second model with a volume of 1560 cm³, simulation (a) reached a volume percentage of 65.15% without arm clash and allowing the multiquadrant advance, while simulation (c) could not be performed due to arm collision and the inability to advance and see the four quadrants. Triangulation and increasing the distance away from the point of interest improve intracorporeal EWS for multiquadrant complex pediatric surgery.