The use of the da Vinci® Surgical System for the treatment of pediatric patients is one of the most compelling applications of robotic-assisted minimally invasive surgery. The minimization of trauma, incision size and the resulting scarring are significant advantages provided by a less invasive surgical approach. The da Vinci System provides the further advantages of a motion scaling and tremor reduction that are critical in work in and around the small anatomical structures of infants and children.
Children's hospitals throughout the world are successfully integrating robotics into their practice, allowing them to perform better surgery and extend the benefits of minimally invasive procedures to children and their families.
- Enhanced 3D visualization
- Improved dexterity
- Increased range of motion
- Improved access
- Procedure conversion to MIS increases procedure value, which can attract higher patient volume
- Shorter hospital stay
- Less post-operative pain
- Less risk of infection
- Less blood loss and need for transfusions
- Less scarring and improved cosmesis
- Faster recovery and quicker return to normal activities
Normally, the kidneys produce urine by filtering the blood and removing waste. The urine drains from each kidney through a collection system that ends in a funnel-shaped structure known as the renal pelvis. It then travels through the ureter and into the bladder. An obstruction at the junction of the renal pelvis and ureter (ureteropelvic junction obstruction) can occur from a congenital narrowing of the ureter or a crossing blood vessel causing a compression on the ureter. The increase in pressure from the obstruction can cause dilation of the renal pelvis (hydronephrosis) and may result in the loss of kidney function. The resulting blockage can be symptom free and is usually detected during routine ultrasound exams. Ureteropelvic junction obstruction can also cause flank pain, bleeding, infection and kidney stones.
The traditional procedure involves making an incision over the affected kidney and identifying the narrowing of the ureter or the crossing blood vessel. The ureter is transected and the narrowing is removed and the ureter and the renal pelvis is reconnected with sutures. In case of crossing vessel, the ureter is transected and brought in front of the vessel and reconnected. Usually a thin plastic tube (stent) is placed from the renal pelvis down the ureter and into the bladder. This procedure is effective but requires a painful incision over the kidney area.
This same procedure can be performed with the assistance of the daVinci Robot Surgical System through four small incisions (8mm). Because of the special robotic instrumentation, cutting and suturing of the delicate structures can be performed more accurately and precisely resulting in less long term scarring. Hospital stay is usually overnight and children and return to school within 2-3 days. Pain is minimal because of the small incisions.
daVinci Ureteral Reimplantation
Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the kidneys and is present in 1% of healthy children. This condition is usually a congenital deformity in which there is an abnormal insertion of the ureter into the bladder causing a short, ineffective flap valve. Reflux of urine can cause infection of the kidney resulting in scarring and damage to the affected kidney.
The majority of the children with vesicoureteral reflux can be treated with antibiotics to prevent further infection of the kidney and resulting scarring of the kidney. Higher grade of reflux or reflux that does not improve over time will require surgical repair. Traditional open surgery for ureteral reimplantation is performed by making an incision (similar to a "c-section" incision) and opening the bladder. The ureter is then dissected from the bladder and tunneled through the bladder wall. It has very high success rates but requires a large incision and extended hospital stay (2-3 days) and extended recovery time.
Using the daVinci Robotic Surgical System, the same procedure can be performed through 4-8mm incisions for a shorter hospital stay (usually overnight) and faster recovery (children can return to school within 2-3 days).