Robot in Kidney Anomalies of Children; Robotic Partial Nephrectomy, Robotic Heminephroureterectomy, Robotic Nephroureterectomy, Robotic ureteroureterostomy, Robotic Simple Nephrectomy, Robotic Radical Nephrectomy
What is renal duplication anomaly?
Kidneys usually have tubular structures called ureters that carry urine to the urinary bladder. Sometimes, a kidney may consist of two separate parts, and both kidney parts may have separate ureters. In these cases, we may encounter urinary drainage blockage in a part of the kidney, affected kidney function, infection, or urinary incontinence for various reasons. Minimally invasive surgical options offered to the family in these anomalies are robotic or laparoscopic partial nephrectomy (removal of part of the kidney), heminephroureterectomy (removal of a part of the kidney and the ureter of that part together), and robotic or laparoscopic ureteroureterostomy (opening one ureter to the other ureter).
What isnon-functional dysplastic kidneys?
During development in the intrauterine period in girls or boys, the kidneys may not develop properly or may not develop at all. Factors that cause the formation of these kidneys can also impair the excretion of the small amount of urine produced. As a result, the urine becomes stagnant, which can cause pain, chronic infection, kidney stones and, rarely, high blood pressure. These kidneys can be removed laparoscopically (laparoscopic simple nephrectomy / nephroureterectomy) or robotically (robotic simple nephrectomy / nephroureterectomy) (figures 1 and 2).
Figure 1: The placement of the robotic trocars and the position in a pediatric patient with a non-functioning and shrunken (atrophic) left kidney and who underwent robotic left nephroureterectomy.
Figure 2: Nephroureterectomy material that I removed with robotic method
Can kidney tumors be seen in children?
Abnormal growths in the kidney can be benign or malignant (figure 3). Although rare in children, kidney tumors can be removed robotically or laparoscopically in a minimally invasive manner. Depending on the size and localization of the tumor, partial or radical nephrectomy may be required. When partial nephrectomy is performed, only the tumor is removed. In radical nephrectomy, the entire kidney is removed.
Figure 3: A 10 cm mass (red star) in the left kidney of a one-year-old patient, the pathology of which was cystic nephroma
Is laparoscopic nephrectomy/heminephroureterectomysafe in children?
Laparoscopy in children has been proven safe and effective and is the most preferred method. In terms of nephrectomy operation, the laparoscopic technique is more advantageous in terms of hospital stay and duration of painkiller use compared to the open method. However, the applicability of laparoscopic operations, especially in small infants and complicated surgeries such as heminefroureterectomy, is still limited to experienced and high-volume centers.
Is robotic nephrectomy/heminephroureterectomysafe in children?
Although such robotic surgeries in children have not reached large series in the literature; The tendency to robotic surgery is increasing with its advantages such as acceptable complication rates, providing three-dimensional high quality and resolution images, providing wide maneuverability, eliminating tremor and being ergonomic. Many authors have reported the application of robotic partial and simple nephrectomy in the pediatric age group.
I perform both laparoscopic and robotic nephrectomy operations for children. However, I think that the use of robots in children can be questioned in terms of cost and expected benefit by the patient in interventions such as nephrectomy, which is why I think laparoscopic nephrectomy will be a more reasonable treatment option. I think that effective visualization and increased surgical skill in the robotic system reduce the risk of vascular injury, so it is a more reasonable option to use the robot in partial nephrectomy or heminephroureterectomy, which is a technically difficult operation, rather than simple nephrectomy.
I performed robotic ureteral reimplantation to the right double system and left heminephroureterectomy to the left in a 22-month-old boy with double ureteron both sides, reflux to the bilateral lower system and non-functioning subsystem on the left (figure 4).
Figure 4: Left hemi-nephroureterectomy excision material of our 22-month-old baby case with bilateral ureter duplication and reflux to the lower kidney system
Does the doctor have an importance in robotic kidney surgery?
As in all urological surgeries, it is very important that the surgeon performing the surgery is experienced. After all, the one who controls the robot is a surgeon. For a successful and smoother operation, it is necessary to have an operation with a doctor who is specialized in robotic surgery.