Robotics In Pediatric Urology: An update Anne-Françoise Spinoit Department of Urology, University Hospital Ghent, Belgium

Challenges in Pediatric Urology RA is made for adults surgery

Challenges in Pediatric Urology

Challenges in Pediatric Urology Pediatric Urologists face an unmet need: Children are not just « small adults » Technological innovations not suitable for kids

Setting RA in pediatrics: know your basics Minimum weight for robotics Anesthesia Positioning Padding Docking

Setting Minimum Weight

Setting Minimum Weight Rule of the 10 kgs child

Setting Anesthesia Importance of dedicated anesthesist Insufflation impairs cardiovasuclar function Insufllation affects ventilation

Setting Anesthesia Insufflation rate based on age or weight – < 1 yr: 0.3 l/min – > 1 yr: 0.5 l/min > 5 yr: 1 l/min >10 yr: 2 l/min Beware rare events: Co2 Embolus: Rt Heart Pneumothorax: acute drop in SpO2

Setting Positioning Essential Avoid bulky padding that just elevates vessels and organs Adapt according to the size of the child Padding of face and organs: not routine in lap, essential in robotic

J Urol 2013; 190:580

Setting Trocar placement and insufflation Open Access in children is the safest technique Complications related to access – 2.3% using Veress access, compared 0.8% using open access CC Passerotti,* et al J Urol 2008;180:681-685 Percutaneous access: Pediatric Abdomen is Too Compliant for this ….!

Setting Extreme compliance

Setting Pediatric Challenges

Setting Indications: know your basics

Setting Indications in RA pediatric urology Totally different compared to yours: no oncology : Wilms tumor : No indication essentially reconstructive urology Pyeloplasty Ureteric reimplantation Ablative surgery essentially for afuncitonal infected organs afunctional kidney Hemi-Nephrectomy for afunctional moeity

Setting Pyeloplasty: Index case Because it is frequent Because suturing is laparascopically demanding Because of improved visualization in difficult cases Because a few steps are ‘robot competence demanding

Pyeloplasty: Index case

Setting Pyeloplasty: Index case Is one of the few procedures where RA, until now, has proven superiority over lap Good knowledge about steps is essential Reconstructive part made easier compared to Lap

Setting Hemi-Nephrectomy : ideal indication Potential complications: Loss of healthy moeity Urine leakage Bleeding Vascular injury Good knowledge about steps is essential Dissection of vessels made easier compared to Lap

Setting Resection of Müllerian remnants

Setting Conclusions Completely different compared to adults !

Robotics in children Anne-Françoise Spinoit Department of Urology, University Hospital Ghent, Belgium