Minimally Invasive Surgery and Robotics

The term 'minimally invasive' typically refers to a procedure performed with the aid of a small telescope and additional specialized instruments that are inserted into the abdomen through tiny incisions. The term 'laparoscopic surgery' may also be used. Since only small incisions are made there is less pain and scarring, the recovery process is usually shorter and children can return to school and usual activity sooner than if a standard open procedure was performed.

As technology and techniques advance more and more surgeries are being done in this fashion. The most commonly performed laparoscopic procedures in pediatric urology include nephrectomy (kidney removal), orchiopexy (bringing the testis down into the scrotum), pyeloplasty (see ureteropelvic junction obstruction) and varicocelectomy (see varicocele).

Recently, the da Vinci Surgical System has made more complex laparoscopic surgeries easier to perform. This system is controlled by a surgeon from a console that is located in the same operating room. The endoscopic camera used by the system has two lenses that give the surgeon full 3-D vision. The da Vinci System scales, filters and translates the surgeon's hand movements into more precise micro-movements of the working arms. These arms have more degrees of movement than the human hand, which makes robotic surgery particularly advantageous for complex procedures that require precise sewing.

Our pediatric urologists have access to a da Vinci System and use it primarily for pyeloplasties in children with ureteropelvic junction obstruction. These children have three or four small abdominal incisions that typically heal almost unnoticeably. Almost all of these children are discharged home within 24 hours of the procedure.