Robotic Bladder Reconstruction Surgery for Children

Benefits of robotic surgery include improved cosmesis, decreased blood loss and recovery time, and shorter hospital stays.

Columbus, OH — January 2018

Traditional laparoscopic bladder reconstruction surgery is usually considered impossible in children. The procedure requires long open times because of its complexity; the patients themselves often have challenging conditions such as spina bifida or bladder and cloacal exstrophy, making a lap procedure even more unlikely.

In what Daniel DaJusta, MDurologist at Nationwide Children’s Hospital, calls an “evolution of laparoscopic surgery,” minimally invasive, complex urological procedures are now possible with the use of a robot. Nationwide Children’s is one of the few institutions in the country performing robotic bladder reconstruction on children.

“The potential benefits are clear,” says Dr. DaJusta, director of robotic urological surgery at the hospital. “Improved cosmesis, of course, but also decreased blood loss and recovery time. We continue to collect data, but we are seeing shorter hospital stays as well.”

Nationwide Children’s uses the da Vinci® Si system, which includes instrumentation that is as dexterous as the human hand, a 3D camera that aids in depth perception and provides 10x visual magnification and tremor reduction. Sitting at a console instead of standing for hours allows for improved surgeon ergonomics as well.

But there is a significant learning curve, Dr. DaJusta says.

Beginners should start with typical laparoscopic procedures such as nephrectomy and pyeloplasty before progressing to more complex procedures. A bedside assistant is needed to help with robot instrument exchanges, retraction and suction. Once the robot is “docked” in place, it can only work in that area, so surgical preplanning is critical.

One of the clear advantages of the robot, however, is the ability to learn through simulation on the robot console. Even experienced surgeons may use the console to “warm up” before surgery.

The success of the program is leading Dr. DaJusta and his colleagues to consider robotic bladder augmentation in the future. The Section of Urology already has a close partnership with the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s, and robotic surgery can allow for Malone and neo-Malone procedures in further collaboration with the center.

“We are going to continue expanding the program because we really do think this is part of the evolution of laparoscopy,” says Dr. Dajusta.