Pediatric urologic robotic surgery – purs

Abstract

Robotically assisted operations are thought be safe both in adult and pediatric patients.In the laboratory setting, the use of robots resulted in quicker and more efficient performance of standardized laparoscopic exercises compared with the standard laparoscopic approach. In comparison to adults, the pediatric patient poses new challenges such as smaller operative fields and more delicate tissues that necessitate fine suture material. Since there are several limitations of conventional endoscopic tools, such as limited instrument mobility or decreased ergonomics, pediatric surgeons are using the robot to assist in their surgical approach. Furthermore, freehand suturing using the available laparoscopic instruments is time consuming and requires vast experience, especially with small suture sizes. Though the robot might occupy most of the extracorporeal space in small children, the surgery is facilitated by the surgeon’s robotic dexterity. Children present a small working environment when compared to adults. For instance, an adult pneumoperitoneum will typically provide a 5–6 L working space where a 1-year-old will present a 1 L intra-abdominal space. Also, the body surface area is smaller and the chance of port site conflicts such as instrument crossing or trocar head piece collisions is greater for children as their size decreases. Tissue handling without haptic (touch) sensation remains a debatable and controversial topic, but with experience, the surgeon uses visual cues to avoid tissue damage and proper tissue realignment. The absence of tactile feedback and the inability to regulate the force applied to the tissues are characteristic of most endoscopic surgical techniques. When performing robotic surgery, the loss of force feedback (haptics) is a natural phenomenon. Surgeons usually rely on visual cues such as tissue compression and blanching as well as suture stretch (e.g., knot deformation) to determine the tensile strength of tissue and sutures. Advances in integrating imaging into the available robotic systems may facilitate surgeon intuition during the planning of complex reconstructions and improves on haptic. Robotics allows in situ surgery with accurate depth perception and tissue interrelations to accurately depict the pathology and correct it without strain on the target organ. The reconstruction can be done with the target organ in its natural position and location, allowing recognition of the interaction with its surroundings and pathology. Robotic-assisted laparoscopy appears to reduce the learning curve of intracorporeal suturing. Part of the learning curve entails organizing and training the right team. In pediatric urology, Peters et al. were the first authors to successfully complete various complex urological procedures while emphasizing the need for the development of a dedicated team approach to robotic surgery.