title: Robotic paediatric urology.
abstract: What's known on the subject? and What does the study add? Robot assisted laparoscopic surgery (RALS) is slowly gaining acceptance in the field of paediatric urology. Accumulating data on safety and efficacy when performing paediatric robotic urologic procedures has led paediatric urologists to gradually embrace increasingly more complex reconstructive surgeries. Indeed, the unique and delicate movements generated by the robotic system make this technology ideal for children who often require reconstructive procedures. We critically review the current role of RALS in paediatric urology and to analyse the published data, with a special emphasis on the most common applications. We also propose a structured plan to expedite training and the surgical 'learning curve'.
  
  
  OBJECTIVE
  To critically review the current role of robot-assisted laparoscopic surgery (RALS) in paediatric urology and to analyse the published data, with a special emphasis on the most common applications. One of the greatest benefits of RALS has been the ability to truly spread the application of minimally invasive surgery to paediatric surgical patients. The unique attributes of the robotic interface make this technology ideal for children with congenital anomalies, who often require reconstructive procedures. We also propose a structured plan to expedite training and the surgical 'learning curve'.
  
  
  METHODS
  Currently, almost all urological surgical procedures in children have been performed with the assistance of the robotic interface. The most commonly performed procedures include pyeloplasty, nephrectomy/hemi-nephrectomy and surgery for vesico-ureteric reflux. Initial series of bladder augmentation and appendicovesicostomy are available.
  
  
  RESULTS
  Initial results with RALS are encouraging and have shown safety similar to open procedures, and outcomes at least equivalent to standard laparoscopy. Accumulating data have consistently shown that postoperative analgesia requirements and overall hospital stay are decreased. However, operative durations are significantly longer than their open counterparts, but this is decreasing as experience accumulates.
  
  
  CONCLUSIONS
  RALS is already part of paediatric urological surgery. Larger single-institution case series and comparative studies with the open approach and multi-institutional meta-analyses will help to identify the benefits of RALS in paediatric urology.
authors.affiliation: Pediatric Urology, Section of Urology –Department of Surgery, University of Chicago, Comer Children's Hospital and Pritzker Medical School, Chicago, IL, USA.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Orvieto
authors.forename: Michael
authors.initials: M
authors.lastname: Large
authors.forename: Mohan S
authors.initials: MS
authors.lastname: Gundeti
mesh_terms: D000818:Animals; D002648:Child; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012371:Robotics / Q000193:education / Q000379:methods; D013520:Urologic Surgical Procedures / Q000193:education / Q000379:methods; D014584:User-Computer Interface