Robotic-Assisted Surgery for Bilateral Vesicoureteral Reflux in a Pediatric Patient
Introduction
Robotic-assisted surgery is transforming pediatric urology by providing unprecedented precision and reducing recovery times for complex procedures. This article discusses a successful case of robotic bilateral ureteral reimplantation performed on a 10-month-old girl diagnosed with bilateral vesicoureteral reflux (VUR) and recurrent urinary infections, underscoring the benefits of the da Vinci Surgical System for both patients and surgeons.
Case Presentation
A 10-month-old girl presented with recurrent fevers due to urinary infections, requiring multiple hospital admissions and intravenous antibiotics. Upon evaluation, she was diagnosed with bilateral VUR, where urine refluxes into the kidneys, leading to swelling and recurrent infections. Following stabilization with antibiotics, robotic surgical intervention was planned to correct the reflux.
Surgical Approach
After exploring the options of open surgery, laparoscopy, and robotic surgery, the decision was made to perform robotic bilateral ureteral reimplantation. Utilizing the da Vinci Surgical System, the surgery was conducted with precision through three small abdominal incisions. Console-controlled robotic instruments provided unparalleled precision and control. This approach minimized blood loss to only 5 ml, allowing the patient to be discharged in a stable condition just two days postoperatively.
Benefits of Robotic Surgery in Pediatric Urology
- Reduced pain: Minimal incisions lead to less discomfort.
- Shorter hospital stays: Faster recovery allows for earlier discharge.
- Quicker recovery: Patients return to normal activities sooner.
- Less blood loss: Typically lower intraoperative bleeding.
- Minimal scarring: Smaller incisions provide better cosmetic outcomes.
- Complex dissections: Enables intricate procedures that may be challenging with traditional methods.
- Improved outcomes and fewer complications: Enhanced precision results in better medical outcomes and lower rates of postoperative issues.
- Tremor filtration: Reduces surgeon hand tremors for smoother movements.
- Better stability of instruments: Enhances handling during delicate procedures.
- 3x10 magnification: Improves visualization of nerves and critical structures.
Impact on Surgical Practice and Patient Outcomes
The da Vinci System has revolutionized the approach to pediatric urology at Yashoda Hospitals, helping surgeons perform even the most complex procedures with enhanced precision and control. This technology enables faster patient recovery, reduced scarring, and improved medical outcomes. For the pediatric urologist in this case, the da Vinci System allowed high control and accuracy, which were critical in achieving a successful outcome for a high-risk, young patient. The patient was monitored in the hospital and discharged on the second postoperative day in stable condition.
Conclusion
Robotic surgery has become an invaluable tool for complex pediatric urology, delivering high safety standards, shorter recovery times, and minimized scarring. In this case, the patient experienced rapid improvement, with successful correction of VUR and a return to normal activities. This highlights the positive impact of robotic-assisted surgery on pediatric patient outcomes and surgical practice, underscoring Yashoda Hospitals’ commitment to innovative, patient-centered care.
More Information about Robotic Surgery in Pediatric Urology at Yashoda Hospitals
Children and adolescents with complex urologic diseases often require surgical intervention. Minimally invasive urologic surgery allows surgeons to operate precisely on the urinary system, including the urinary tract, bladder, and kidneys. When complex reconstruction is needed, robotic surgery offers enhanced capabilities, replicating the surgeon’s hand movements and providing a 3D view of the surgical field, resulting in minimal tissue trauma.
At Yashoda Hospitals, we perform robotic surgeries for various urological conditions in patients as young as one month old. Our dedicated team focuses on achieving excellent outcomes, rapid recovery, and minimal pain. Common robotic procedures include:
- Pyeloplasty
- Ureteral reimplantation
- Ureteroureterostomy
- Nephrectomy
- Hemi-nephrectomy
- Appendicovesicostomy (for neurogenic bladder)
- Bladder diverticulectomy
- Ureterocalicostomy
- Bladder augmentation (for neurogenic bladder and exstrophy)
- Bladder neck repairs (for incontinence)
Our patients benefit from state-of-the-art instrumentation, specialized pediatric anesthesiology, and pain management expertise, ensuring effective pain control with reduced medication.
FAQs on Robotic Surgery in Pediatric Urology
Â
How does robotic surgery work in pediatric urology?
Robotic surgery in pediatric urology is an innovative technique in minimally invasive surgery. It combines the precision of traditional open surgery with the benefits of reduced recovery times associated with minimally invasive approaches. During the procedure, the surgeon operates from a console, controlling robotic arms that enhance their dexterity and precision. This system is particularly beneficial for accessing small anatomical areas in children, allowing for meticulous surgical maneuvers without tremors. The result is improved outcomes for intricate urological procedures.
Which pediatric urological procedures are performed robotically?
Robotic technology is utilized for various complex pediatric urological procedures. The most common procedures include ureteropelvic junction obstruction (UPJ) repair, bladder augmentation, ureteric reimplantation, appendicovesicostomy, and surgeries related to the kidneys and urinary tract. These procedures benefit from the enhanced precision and control provided by robotic assistance.
What are the benefits of robotic surgery in pediatric urology?
Robotic surgery offers several advantages over traditional open surgery. It typically results in smaller incisions, which leads to reduced postoperative pain, shorter hospital stays, and quicker recovery times. Patients undergoing robotic surgery often return to normal activities within a few days, allowing parents to resume work sooner. Additionally, the robotic system provides superior dexterity and visibility, enabling surgeons to perform complex procedures more effectively.
What is the eligibility for robotic pediatric urosurgery?
Eligibility for robotic pediatric urosurgery is determined by a thorough assessment of the child’s physical examination, medical history, and diagnosis. While robotic surgery can be suitable for many pediatric patients, it is less frequently performed on newborns unless conducted by highly experienced surgeons.
What is the recovery time after pediatric urology robotic surgery?
Postoperative recovery after robotic surgery is typically swift. Children generally remain in the postoperative ward for about 24 hours, during which a catheter may be in place for an additional 24 to 48 hours. Overall, hospitalization and recovery times for robotic surgery are significantly shorter than for open surgery and often more favorable than for laparoscopic surgery. Most children can resume their normal activities within a few days.
What is the success rate of robotic surgery?
The success rate of robotic surgery in pediatric urology is comparable to or even exceeds that of traditional surgical methods. This ensures that patients receive effective care with positive outcomes.
Why is robotic surgery not very popular in India?
The limited popularity of robotic surgery in India is primarily due to the shortage of trained and experienced robotic surgeons. Additionally, there is a need for greater awareness and understanding of this surgical option among parents and pediatricians, which could facilitate its adoption.
What if equipment fails during the operation?
Equipment failure during robotic surgery is rare. However, in the unlikely event that an issue arises, the surgeon is trained to perform the procedure laparoscopically. This capability is reliant on the surgeon’s experience, as they incorporate all necessary safeguards during the operation.
About Author –
Dr. Mallikarjuna Reddy N, Sr. Consultant Urology & Robotic Surgery
Clinical Director , Yashoda Hospital, Hyderabad
MBBS, MS, MCh, DNB (Urology), Fellow European Board of Urology
