Upasani Anand, Mariotto Arianna, Eassa Waleed, Subramaniam Ramnath
Paediatric Urology Department, Leeds Teaching Hospital NHS Trust, Leeds, UK.
Paediatric Urology Center, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
Transl Pediatr. 2023 Aug 30;12(8):1540-1551. doi: 10.21037/tp-22-533. Epub 2023 Aug 17.
Robotic approach is used widely for paediatric upper tract urinary reconstruction. This is a narrative review looking at the current status of robotic approach in lower urinary tract reconstruction. The aim of this article is to highlight the important technical aspects of commonly performed robotic lower urinary tract reconstructive surgeries and review the current literature.
MEDLINE database search was conducted using MeSH terms and Boolean operators from Jan 2000 to Jun 2022. Abstracts were screened to exclude those in languages other than English as also articles pertaining to (I) upper urinary tract surgery, (II) only laparoscopic surgery (not robot-assisted) and (III) non-urological topics. Selected articles were then reviewed and search expanded to include their references with a focus on advanced lower urinary tract reconstruction.
The technical aspects of robotic ureteric reimplantation, continent catheterisable channel and autoaugmentation are discussed in detail. The early outcomes are comparable to open surgery. The true advantage of robotic approach becomes apparent when performing lower urinary tract reconstruction, where space in the pelvis is limited and access is challenging. Only a few centres are currently performing bladder neck surgery and bladder augmentation.
Robotic lower urinary tract reconstruction in children is feasible and safe. Robotic approach offers better access, especially in the limited space within the pelvis. It reduces blood loss and post-operative pain allowing early recovery and discharge. Long-term follow-up with increasing experience could further validate these early observations.
机器人手术方法在小儿上尿路重建中被广泛应用。本文是一篇叙述性综述，探讨机器人手术方法在小儿下尿路重建中的现状。本文旨在强调常见机器人辅助下尿路重建手术的重要技术要点，并对当前文献进行综述。
使用医学主题词（MeSH）和布尔运算符在2000年1月至2022年6月期间对MEDLINE数据库进行检索。筛选摘要以排除非英语语言的文章以及与以下内容相关的文章：（I）上尿路手术；（II）仅腹腔镜手术（非机器人辅助）；（III）非泌尿外科主题。然后对选定的文章进行综述，并扩大检索范围以纳入其参考文献，重点关注晚期下尿路重建。
详细讨论了机器人输尿管再植术、可控性尿流改道术和膀胱自体扩大术的技术要点。早期结果与开放手术相当。当进行骨盆空间有限且手术入路具有挑战性的下尿路重建时，机器人手术方法的真正优势就变得明显。目前只有少数中心开展膀胱颈手术和膀胱扩大术。
小儿机器人辅助下尿路重建是可行且安全的。机器人手术方法提供了更好的手术入路，尤其是在骨盆内有限的空间中。它减少了失血和术后疼痛，使患者能够早期康复并出院。随着经验的增加，长期随访可能会进一步验证这些早期观察结果。
