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Robotic SurgeryPediatric Urology
Robotics Center

Robotic technology has been an incredible advance in the field of surgery. Adult urologists were among the first users of this equipment. It wasn't long before pediatric urologists recognized the benefits.

The staff of Pediatric Urology Associates, of the Pediatric Urology Robotics Center, has the most extensive experience in the Tri State area in robotic surgery in children.

Robotic Surgery at PUA

The advantages of robotic surgery have made us so enthusiastic about its use. Surgery done robotically results in less pain, less scarring and quicker recovery than traditional open surgery. And the quicker children returned to their activities, the quicker parents can return to their activities.

Robot instruments have many different joints that allow for the instruments to operate exactly like
human fingers wrists and hands.

These miniature instruments are introduced into the body through trocars (thin tubes). Therefore
large incisions are not necessary. The dexterity of the instruments allow for us to do incredibly
fine work with great precision.


 

URETEROPELVIC JUNCTION OBSTRUCTION


Perhaps the most common usage of robotic surgery in pediatric urology is to repair a UreteroPelvic Junction (UPJ) obstruction. This procedure is called a pyeloplasty. In this condition a small portion of the ureter needs to removed as it is obstructing the kidney. UPJ obstruction can be discovered with sonograms done during pregnancy, following a urinary tract infection, or in the course of an evaluation for abdominal pain. The segment that is causing the obstruction either is blocked due to a narrowing; or does not do its job of peristalsis (pushing the urine forward) due to a lack of muscle; or gets kinked as it lies over a blood vessel.

Illustration of UPJ Obstruction

Illustration of UPJ Obstruction


After the abnormal section is removed, the healthy ureter is reattached to the renal pelvis. The ureter is only a little bigger than a piece of spaghetti and the sutures used are the size of a hair. The robotic instruments allow for far greater dexterity than standard laparoscopy. As opposed to open surgery, with its larger flank incision, the robotic procedure is done through several small incisions the size of a pen. The procedure is highly successful and patients are typically discharged home in 12 days.

Repair of UPJ Obstruction (Pyeloplasty)
Repair of UPJ Obstruction (Pyeloplasty)

PARTIAL NEPHRECTOMY
In certain conditions such as ectopic ureter or ureterocele, a diseased portion of the kidney may need to be removed. Robotic surgery allows for this removal with meticulous control of the blood vessels, ureter and kidney tissue. Robotic surgery for partial nephrectomy eliminates the need for open flank surgery and allows for quicker recuperation and better cosmetic outcome.


NEPHROURETERECTOMY
Occasionally an entire kidney and its ureter may need to be removed. This can occur with severe reflux or severe obstructions such as megaureter. Open surgery requires both a flank incision and a lower abdominal incision. Robotic surgery allows the procedure to be done with its small trocars and no large incisions.

Nephroureterectomy specimen and the trocar sites used for its removal.

Nephroureterectomy specimen and the trocar sites used for its removal.


URETERAL REIMPLANTATION

Incision is made in the bladder wall and the ureter is implanted underneath the muscle

Incision is made in the
bladder wall and the ureter
is implanted underneath
the muscle

Urinary reflux is treated in a variety of ways depending on many factors including the degree of reflux, the child’s age, the presence of infections etc. One of the options for treating reflux is surgery. Robotic surgery for reflux achieves the same goals as open surgery, namely to create a longer tunnel for the ureter in the bladder. Not only are the standard advantages of robotic surgery present, but because the robotic surgery is done by an extravesical approach (outside the bladder), there is less bleeding, bladder spasm and catheter time than when surgery is done via an open approach.

MITROFANOFF
When a child is unable to empty their bladder (usually in conditions such as spina bifida), the bladder can be drained with intermittent catheterization of the urethra. However if access to the urethra is difficult, a creative surgery called the Mitrofanoff procedure allows access to the bladder. In the Mitrofanoff procedure, one end of the appendix is connected to the bladder and one end is connected to the skin (often in the belly button). A catheter can then be easily inserted into the bladder by lifting or unbuttoning a few buttons of the shirt. Families feel this gives the child more independence for their bladder schedule. Robotic surgery has been used to perform this surgery with good results.



Catheter inserted into the 
Mitrofanoff stoma, through the abdominal wall and into the bladder.

Catheter inserted into the
Mitrofanoff stoma,
through the abdominal wall
and into the bladder.


MACE PROCEDURE

Mace Stoma

Irrigation of colon via MACE stoma
produces reliable bowel movements.
Constipation can be a challenge for children with spina bifida and other neurological conditions. When rectal enemas are no longer an option, the MACE procedure (Malone Antegrade Continence Enema) offers predictable emptying of the colon. In this procedure the appendix is brought to the skin to allow passage of a catheter into the colon and irrigation of the colon. This procedure allows for quick, easy and predictable bowel emptying. Families are often quite happy with the improvement this offers over rectal enemas.

ADRENAL TUMORS
Adrenal tumors can be benign or malignant. Removing them in the past required large flank or abdominal incisions. However some of these tumors can be removed with robotic surgery allowing for quicker recuperation.