Larger studies on robot-assisted laparoscopic surgery needed to identify its benefits in paediatric urology

Monday, 2 April 2012- 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.

M. Orvieto and colleagues conducted a critical review of the current role of RALS in paediatric urology and analysef the published data, with a special emphasis on the most common applications. They also proposed a structured plan to expedite training and the surgical ‘learning curve.’ They published a report in the March 19, 2012 online edition of BJU International.

The researchers aimed 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,” Orvieto wrote.

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.

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.

“RALS is already part of paediatric urological surgery,” according to the researchers. They added: “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.”

Source: M. Orvieto, et al., “Robotic paediatric urology,” BJU International; DOI: 10.1111/j.1464-410X.2011.10877.x

 

Filed by: JV


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