Mayo Clinic Rochester, Department of Urology, 200 1st Street Sw, Rochester, MN 55905, USA.
J Pediatr Urol. 2021 Jun;17(3):424-425. doi: 10.1016/j.jpurol.2021.03.021. Epub 2021 Mar 28.
Pediatric surgery began with single-incision flank surgery and has evolved to multi-port laparoscopic and robotic approaches. Recent technological advances with the single-port (SP) robot have allowed for transition back to single-incision surgery.
A 14-year-old paraplegic male with T2 spinal injury presented with neurogenic bladder and increasing difficulty performing clean intermittent catheterization thus the decision was made to perform the first SP robotic Mitrofanoff procedure in a pediatric patient. The SP platform has one 2.5 cm, 4-channel port, a 12 × 10 mm articulating camera, and 6 mm multi-wristed instruments.
The SP robotic Mitrofanoff was completed successfully without issues with space, triangulation or articulation. There is, however, loss of insufflation with use of laparoscopic instruments as the seal on the port is difficult to maintain. The single-port robot has been successfully utilized in seven patients: six underwent dismembered pyeloplasty and one underwent Mitrofanoff with a median operative time of 120 min and estimated blood loss of <25 cc. Postoperatively, no patients required opioid pain medications, and all were discharged in <24 h without complications.
Single-port robotic surgery is feasible in pediatric patients, but patient selection is key. Future development of the platform is needed to widen application to smaller patients.
小儿外科学始于单切口侧腹手术，现已发展为多孔腹腔镜和机器人手术。单端口（SP）机器人的最新技术进步使得手术能够重新回到单切口手术。
一名 14 岁的截瘫男性，T2 脊髓损伤，患有神经性膀胱，间歇性导尿越来越困难，因此决定为该患者进行首例 SP 机器人 Mitrofanoff 手术。SP 平台有一个 2.5 厘米、4 通道端口、一个 12×10 毫米的铰接式摄像头和 6 毫米多腕器械。
SP 机器人 Mitrofanoff 手术成功完成，没有出现空间、三角定位或铰接问题。然而，由于难以保持端口密封，使用腹腔镜器械时会失去充气，这是一个问题。该单端口机器人已成功用于 7 名患者：6 名患者接受了离断性肾盂成形术，1 名患者接受了 Mitrofanoff 手术，中位手术时间为 120 分钟，估计出血量<25 毫升。术后，无患者需要阿片类止痛药，所有患者均在 24 小时内出院，无并发症。
单端口机器人手术在儿科患者中是可行的，但患者选择是关键。需要进一步开发平台，以扩大其在较小患者中的应用。
