Robot-assisted reconstructive surgery of lower urinary tract in children: a narrative review on technical aspects and current literature

BACKGROUND AND OBJECTIVE: 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. METHODS: 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. KEY CONTENT AND FINDINGS: 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. CONCLUSIONS: 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.