Robotic Bladder Outlet Procedures

This book presents the state of the art across the entire field of pediatric robotic surgery, including thoracic, abdominal, oncologic, gynecologic, and urologic procedures. Indications for each type of robotic surgery are clearly set out and technical aspects are described in detail, illustrating the patient’s position and explaining the robotic assessment and the optimal use of robotic instruments. Anesthetic issues and the management of robotic complications are discussed, and managerial aspects are also considered, with provision of helpful suggestions on how to approach robotic surgery in each pediatric department. For surgeons who wish to start using the pediatric robotic approach, simple illustrations of robotic assessment and principles of robotic surgery are included. Pediatric robotic surgery has undergone significant development in recent years, and the technology is now applied to a variety of pediatric diseases beyond urology. This book has been written by a group of world-renowned pioneers of pediatric robotic surgery and will appeal to pediatric surgeons of all disciplines, to residents, and to hospital general managers and medical directors

Pure robotic retrocaval ureter repair

PURPOSE: To demonstrate the feasibility of pure robotic retrocaval ureter repair. MATERIALS AND METHODS: A 33 year old female presented with right loin pain and obstruction on intravenous urography with the classical "fish-hook" appearance. She was counseled on the various methods of repair and elected to have a robot assisted repair. The following steps are performed during a pure robotic retrocaval ureter repair. The patient is placed in a modified flank position, pneumoperitoneum created and ports inserted. The colon is mobilized to expose the retroperitoneal structures: inferior vena cava, right gonadal vein, right ureter, and duodenum. The renal pelvis and ureter are mobilized and the renal pelvis transected. The ureter is transposed anterior to the inferior vena cava and a pyelopyelostomy is performed over a JJ stent. RESULTS: This patient was discharged on postoperative day 3. The catheter and drain tube were removed on day 1. Her JJ stent was removed at 6 weeks postoperatively. The postoperative intravenous urography at 3 months confirmed normal drainage of contrast medium. CONCLUSION: Pure robotic retrocaval ureter is a feasible procedure; however, there does not appear to be any great advantage over pure laparoscopy, apart from the ergonomic ease for the surgeon as well the simpler intracorporeal suturing