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Review
. 2023 Aug 30;12(8):1540-1551.
doi: 10.21037/tp-22-533. Epub 2023 Aug 17.

Robot-assisted reconstructive surgery of lower urinary tract in children: a narrative review on technical aspects and current literature

Anand Upasani  1 , Arianna Mariotto  1 , Waleed Eassa  2 , Ramnath Subramaniam  1
Affiliations
Review

Robot-assisted reconstructive surgery of lower urinary tract in children: a narrative review on technical aspects and current literature

Anand Upasani et al. Transl Pediatr. .

Abstract

Background and objective: Robotic approach is used widely for paediatric upper tract urinary reconstruction. This is a narrative review looking at the current status of robotic approach in lower urinary tract reconstruction. The aim of this article is to highlight the important technical aspects of commonly performed robotic lower urinary tract reconstructive surgeries and review the current literature.

Methods: MEDLINE database search was conducted using MeSH terms and Boolean operators from Jan 2000 to Jun 2022. Abstracts were screened to exclude those in languages other than English as also articles pertaining to (I) upper urinary tract surgery, (II) only laparoscopic surgery (not robot-assisted) and (III) non-urological topics. Selected articles were then reviewed and search expanded to include their references with a focus on advanced lower urinary tract reconstruction.

Key content and findings: The technical aspects of robotic ureteric reimplantation, continent catheterisable channel and autoaugmentation are discussed in detail. The early outcomes are comparable to open surgery. The true advantage of robotic approach becomes apparent when performing lower urinary tract reconstruction, where space in the pelvis is limited and access is challenging. Only a few centres are currently performing bladder neck surgery and bladder augmentation.

Conclusions: Robotic lower urinary tract reconstruction in children is feasible and safe. Robotic approach offers better access, especially in the limited space within the pelvis. It reduces blood loss and post-operative pain allowing early recovery and discharge. Long-term follow-up with increasing experience could further validate these early observations.

Keywords: Robotic surgery; lower urinary tract reconstruction; paediatric urology.

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Conflict of interest statement

Conflicts of interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-533/coif). The series “Pediatric Robotic Surgery” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Ports and theatre layout. (A) Positioning of patient, robot, console & teams in theatre room. (B) Ports and robot positioning: 1, camera port; 2 and 3, working ports; 4, accessory port.
Figure 2
Figure 2
VUJ dissection and transabdominal stay stitch to improve exposure, in a patient previously treated with endoscopic correction. VUJ, vesico-ureteric junction.
Figure 3
Figure 3
Tapering technique. (A) Ureteric segment for trimming is identified, hitched to the abdominal wall and the incision line is marked. (B) Megaureter trimmed. Trim line to face bladder mucosa when laid within the detrusorotomy. (C) Tailoring performed with inverting PDS 5/0 sutures. (D) Double J stent placed percutaneously. Fashioning of the neo-ureterovesicostomy with PDS 5/0. (E) Detrusor wrap closed using PDS 5/0. PDS, polydioxanone suture.
See this image and copyright information in PMC

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