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

2. Challenges in Pediatric Urology
RA is made for adults surgery

3. Challenges in Pediatric Urology

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

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

6. Setting
Minimum Weight

7. Setting
Minimum Weight
Rule of the 10 kgs child

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

9. 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

10. 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

11. J Urol 2013; 190:580

12. 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:
Percutaneous access:
Pediatric Abdomen is Too Compliant for this ….!

13. Setting
Extreme compliance

14. Setting
Pediatric Challenges

15. Setting
Indications: know your basics

16. 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

17. 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

19. Pyeloplasty: Index case

20. 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

21. 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

22. Setting
Resection of Müllerian remnants

23. Setting
Conclusions
Completely different compared to adults !

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