Robotic-assisted laparoscopic surgery in children offers many potential advantages over open or conventional laparoscopic surgery, particularly for reconstructive urinary tract operations. This surgery also overcomes some of the challenges that are inherent to traditional laparoscopy. These considerations include:
• 3D visualization for the surgeon, and potentially the assistants, if they have a 3D screen available.
• Enhanced visualization; the surgeon controls the operating camera and has operative magnification as high as X12, and it is adjustable.
• Improved dexterity; suturing using the robotic instruments is significantly easier than with laparoscopic suturing and is easier to master.
• The surgeon can perform an anastomosis or tie sutures either left- or right-handed.
• Small sutures, particularly 6-0 and 5-0 monofilament sutures, can be used for an anastomosis much more easily than with conventional laparoscopy.
• During intraoperative suturing, the robotic controls avoid surgeon tremor.
• It is straightforward to work in a small space to perform a reconstructive procedure, such as a pyeloplasty.
• Placement of an antegrade double-J ureteral stent is straightforward.
• Improved ergonomics; the surgeon and the assistants can sit during operation, and experience less fatigue.
• Patient benefits include shorter convalescence, decreased blood loss, improved cosmesis, and decreased postoperative pain.
The purported disadvantages of the da Vinci Surgical System include the lack of haptic feedback, the length of time that it can take to set up and take down the robotic system, and the risk of a mechanical malfunction. Although there is no haptic feedback, the “feedback” becomes visual with regard to tissue dissection, cutting tissue, and so on. With regard to the time duration, for extirpative procedures such as a simple nephrectomy for a nonfunctioning kidney, laparoscopy probably take less time, but the significant advantages in reconstructive procedures such as pyeloplasty and ureteral reimplantation significantly outweigh those of traditional laparoscopy. With regard to mechanical malfunction, current systems are highly reliable.
