Robot-assisted surgery on the upper urinary tract in children

Background. Robot-assisted surgery in pediatric urology is developing most rapidly among other surgical disciplines in the direction of simple to complex reconstructive interventions, including operations on various parts of the ureter. The purpose of this article is to present the current capabilities of robotic surgery in performing surgical procedures on the upper urinary tract in children. Material and methods. The scientific study was carried out at the Irkutsk State Regional Children’s Clinical Hospital from December 2022 to July 2024. Over the entire period, 49 robot-assisted procedures on the ureters were performed. Robotic assisted surgeries are performed using the new Versius platform from CMR (Cambridge Medical Robotics, UK). All surgical procedures were performed according to the same principles and patterns that we adopted from the very beginning of our experience with the Versius system. In all cases, three robotic ports were used: one 12-mm trocar for optics (inserted at the level of the umbilicus in an open manner) 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 geographic location, surgical details, and early and long-term complications. Results. The total number of patients included in this study was 42, of which 26 (62%) were boys and 16 (38%) girls. The average age at the time of surgery was 10.9±4.1 years (median — 11.0 [8.0; 15.0] years), the average weight at the time of surgery was 41.1±19.1 kg (median — 45.0 [23.5; 55.5] kg). As agreed, the implementation of robotic procedures was distributed as follows: proximal segment 32 operations (78%); middle segment — 4 operations (11%); distal segment — 6 operations (11%). Robot-assisted ureteral surgeries include the following procedures: pyeloplasty — 27 patients (64%); — Hellström—Chapman operation — 3 patients (7%); — end-to-side ureteroureteroanastomosis — 2 patients (5%); end-to-end ureteroureteroanastomosis — 3 patients (7%); ureterolithotomy — 1 patient (3%); ureteral reimplantation — 6 patients (14%). The average operation time was 155.0±46.1 minutes (median — 145.0 [128.0; 198.0] minutes). The operations were not accompanied by intraoperative complications. In the early and late period after the operation, no significant reoperations were noted. Conclusion. Initial experience with robotic surgery has confirmed that robotics can be used safely and effectively in children with ureteral pathology.