Integration of the da Vinci System Into Pediatric UrologyĪdaptation of the robot into adult urology first occurred for prostatectomy ( 6), and pediatric urology soon followed with the first robotic pyeloplasty ( 7). Furthermore, with progressing editions (S, Si, Xi, and X), Intuitive Surgical has advanced the system's visualization and instrumentation, as well as its teaching capabilities with dual-console systems and skill simulators. Some key components included the 4th arm for retraction, 3-D visualization, 7-degree range of motion and tremor elimination. The introduction of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) in 1999 addressed many of the basics compromises encountered in laparoscopy ( 5).
Specifically in pediatrics, the need for more delicate tissue handling and adaptation to a smaller operative working space posed a further challenge in minimally invasive surgery ( 4). Although laparoscopy enabled smaller surgical scars and decreased hospital stays, widespread use in complex reconstructive cases did not occur due to limitations on surgeon dexterity with available laparoscopic instruments, visualization, and sensory feedback ( 2, 3). The introduction of laparoscopy for children with non-palpable testicles in the 1960s has led to widespread adoption within the field of pediatric urology, and even replaced open surgery in some situations as the gold standard ( 1). As technology progresses, the understanding of and access to these new robotic platforms will help guide pediatric urologists into the next forefront of minimally invasive surgery. In this report, we review the present and upcoming technological advances of the current Da Vinci surgical systems as well as various new robotic platforms, each offering a unique set of technological advantages. These new robotic platforms include improved haptic feedback systems, flexible scopes, easier maneuverability, and even adaptive machine learning concepts to bring robotic assisted laparoscopic surgery to the next level. As pediatric urology continues to utilize robotic technology for minimally invasive surgery, there is hope that additional pediatric-friendly instruments and components will be developed, either by Intuitive Surgical or one of the new robotic platforms in development that are working to address many of the shortcomings of current systems. Due to the smaller pediatric market, less focus appears to have been placed on the development of the smaller 5 mm instruments. However, limitations of the Da Vinci Surgical Systems still exist despite its continued technological advances over multiple generations in the past 20 years. After starting with pyeloplasty, the use of robotic technology with pediatric urology has expanded to include ureteral reimplantation and even more complex reconstructive procedures, such as enterocystoplasty, appendicovesicostomy, and bladder neck reconstruction.
The introduction of three-dimensional visualization, tremor elimination, a 4th arm, and 7-degree range of motion allowed a significant operator advantage over laparoscopy, especially for anastomotic suturing.
The initial surgical advantage seen in adults was for robotic prostatectomy, and over time this expanded to the pediatric population with robotic pyeloplasty. Since the introduction of the Da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) in 1999, the market for robot assisted laparoscopic surgery has grown with urology. 2Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.1Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States.
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