BERKELEY, CA (UroToday.com) - Robotic paediatric urology is evolving. In our recently published paper we discuss the technicalities entailed in the robotic approach to paediatric pyeloplasty, ureteric reimplantation, diverticulectomy, and appendicovesicostomy. The challenges with each of these procedures are discussed. Although there is a paucity of literature regarding availability of randomized studies comparing the results of traditional laparoscopic and open approaches with the robotic, the case series suggests comparable results, with the advantages of ease of suturing. As highlighted in this article, the challenges in this age group include the small working space available intra-abdominally and a tendency toward ill-designed smaller robotic instruments. The challenges are magnified as longer lengths of instruments remain extracorporeally, thus creating additional interference. The major hindrances in the development of paediatric robotics are first, the differences in practice patterns in paediatric urology compared to adult urology, thereby making development of expertise difficult; second, it is challenging to conduct proper studies in the paediatric population because of a paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomized study, difficulties with blinding, the potential ethical issues involved, and lastly, the instruments, although in an evolutionary phase, continue to require improvement.
More complex surgeries can also be dealt with safely and effectively with robots. For instance, length of hospitalization and the requirement for post-operative analgesics are significantly reduced. Operative times, however, are significantly higher when compared to open approach, although this is a matter of experience. As surgeon experience improves, the results will become evident. Larger studies, both single centre or multicenter, as well as comparative studies examining open standard laparoscopy and robotic surgeries, are required to demonstrate the benefits of robotic surgery in paediatric urology over open methods.
Arvind P. Ganpule as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Muljibhai Patel Urological Hospital, Dr. Virendra Desai Road, Nadiad - 387 001, Gujarat, India