Limitations and complications of robotic urological surgery in younger children: debunking old beliefs.

Introduction: Even though certain technical limitations associated with the small size of the patients were taken for granted in the advent of pediatric robotic surgery, we could now be facing a paradigm shift challenging these old beliefs.

Materials and methods: A retrospective study of patients undergoing Da-Vinci-Xi(IS4000)-assisted urological surgery from May 2022 to October 2023 was carried out. Patients were divided into two groups -Group A < 15 kg and Group B ≥ 15 kg. Operating times, hospital stay, and intra- and postoperative complications were compared.

Results: 17 patients (9 in Group A, 8 in Group B) underwent surgery. Median age was 29 months (A) and 109 months (B) (p< 0.001). Median weight was 12.0 kg (A) and 31.5 kg (p< 0.001). Operating time was 162 min (A) and 130 min (p= 0.203). Console time was 99 min (A) and 70 min (B) (p= 0.065). Mean hospital stay was 2 days (A) and 3 days (B) (p= 0.41). No differences were found in terms of intraoperative (p= 0.453) or postoperative (p= 0.485) complications.

Conclusions: Even though operating on younger children seemed more complicated than on older ones in the advent of robotic surgery, the results in our series were similar. The fact patients under 12 months of age were not included means larger studies are required to prove this.