“Robotic pediatric urology.”
Casale, P. (2009).
Curr Urol Rep 10(2): 115-8.
Robotic-assisted minimally invasive surgery is penetrating pediatric urology. The freedom afforded by the “surgical actuators” has led to the expanding adoption of robotics, and it is unlikely that much of laparoscopy will not trend toward some iteration of robotic influence. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) provides delicate telemanipulation, coalesced with three-dimensional visualization and superior magnification. It has bridged the gap between laparoscopy and open surgery. Nonetheless, a confident understanding of pure laparoscopy is paramount in the event that mechanical malfunction is experienced. Robotic pediatric urologic procedures such as pyeloplasty, ureteral reimplantation, abdominal testis surgery, and partial or total nephrectomy with or without ureteral stump removal are routinely performed at select centers offering robotic expertise. Complex reconstructive surgeries such as appendicovesicostomy, antegrade continent enema creation, and augmentation cystoplasty can be performed but are still in their infancy.
“Intraoperative ultrasound: application in pediatric pyeloplasty.”
Ginger, V. A. and T. S. Lendvay (2009).
Urology 73(2): 377-9; discussion 379.
OBJECTIVES: To describe a simple method of using a readily available portable ultrasound device to confirm distal stent placement for antegrade placed stents. Antegrade placement of internal double-J ureteral stents during open or laparoscopic pyeloplasty has become an alternative to retrograde placement but might be less reliable owing to the lack of confirmation of the distal stent position. METHODS: The SonoSite S-Nerve ultrasound system was used with a L38 x 10-5 MHz linear array transducer to evaluate the distal curl of the double-J stent within the bladder intraoperatively during da Vinci robotic-assisted pyeloplasty. The patient did not require repositioning or removal of the robotic arms. RESULTS: Visualization of the stent was successful in all patients with an age range of 8 months to 17 years. CONCLUSIONS: We present the first published method of using ultrasonography to assess and confirm distal stent placement intraoperatively during antegrade stent placement. This simple method uses off-the-shelf equipment available within most operating rooms. In addition, intraoperative ultrasound confirmation of double-J stent placement allows for the ease of antegrade placement with the distal visual confirmation of the stent position without necessitating fluoroscopy or patient repositioning.
“Pediatric robotic-assisted laparoscopic diverticulectomy.”
Meeks, J. J., J. A. Hagerty, et al. (2009).
Urology 73(2): 299-301; discussion 301.
Congenital bladder diverticula are rare anomalies of the bladder. Patients present with infection, hematuria, and/or urinary obstruction. We report on the case of a 12-year-old boy who developed gross hematuria and recurrent infection owing to a 12-cm bladder diverticulum. Robotic-assisted laparoscopic diverticulectomy was performed. We describe the first reported robotic-assisted laparoscopic diverticulectomy in a pediatric patient.
“Feasibility of complex minimally invasive surgery in neonates.”
Sinha, C. K., S. Paramalingam, et al. (2009).
Pediatric Surgery International, Springer-Verlag: 1-5.