Russia’s first experience in robot-assisted surgery in pediatric urology

Abstract

Robot-assisted surgery in pediatric urology is developing most intensively among other surgical disciplines in the direction from simple to complex reconstructive interventions. The purpose of the Article is to summarize the current state of the problem of robotic surgery in pediatric urology and evaluate its future possibilities. The scientific study was carried out at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Dec. 2022-May 2023. 19 robot-assisted procedures were performed over the entire period. Robotic surgeries were performed using the new Versius robotic platform by Cambridge Medical Robotics (UK). All surgical procedures were performed according to the same principles as well as the pattern Authors have previously adopted from the very beginning of their own experience with the Versius system. In all cases, three robotic ports were used: a single 12 mm trocar for optics (openly inserted at the level of the umbilicus) and two 5 mm trocars for robotic manipulators. Additionally, a 5-mm laparoport was installed for the assistant to work during the robotic operation. The study recorded patients' perioperative parameters related to demographics, surgical details and both early- and long-term outcomes. Results: 19 patients were included in the study (11 (58 [34; 80]%) boys/8 (42 [20; 66]%) girls) with the age the surgery was performed in 10.4±4.2 years old (median - 10.0 [7.0; 14.5] y/o) and the weight at the surgery 41.0±16.2 kg (median - 41.0 [27.0; 54.3] kg). Robot-assisted operations in pediatric urology were represented by the following procedures: pyeloplasty in 6 (32 [13; 57]%); removal of a kidney cyst in 5 (26 [9; 51]%); nephrectomy in 4 (21 [6; 46]%); Hellström-Chapman in 1 (5 [0; 26]%) and resection of the bladder diverticulum in 1 (5 [0; 26]%) patient. The mean duration of surgical intervention was 142.2±49.7 min (median - 140.0 [110.0; 160.0] min). Interventions were not accompanied by intraoperative complications. No significant complications were noted in both early and late postoperative periods. Conclusion: initial experience with robotic-assisted surgery confirmed that robotics can be safely and effectively used in children with urological pathology.