The Role of Robotic Surgery in the Management of Vesico-Ureteral Reflux in Children

Dr. Geeta Kekre — Wed, 07 Jun 2023 12:40:24 +0000

Vesicoureteral reflux (VUR) is a common condition in children where urine flows backward from the bladder to the kidneys. If left untreated, VUR can lead to kidney damage and urinary tract infections. Robotic surgery has emerged as a valuable tool in the management of VUR in children

Understanding VesicoUreteral Reflux (VUR)

VUR occurs when the valve between the bladder and the ureter, the tube connecting the bladder to the kidneys, does not function properly. This allows urine to flow back into the kidneys, increasing the risk of kidney infections and potential kidney damage. VUR is often diagnosed in early childhood, and its severity is graded based on the amount of reflux and the potential for kidney damage.

The Role of Robotic Surgery in Vesicoureteral reflux (VUR)

Robotic surgery has revolutionized the treatment of VUR in children, offering several advantages over traditional open surgery or laparoscopic techniques. Dr. Geeta Kekre, a highly skilled pediatric surgeon in Pune, utilizes robotic surgery to provide optimal outcomes for her young patients with VUR.

Benefits of robotic surgery in the management of VUR:

Precision and Visualization: Robotic surgery offers enhanced visualization and precise movements, allowing surgeons like to perform complex procedures with greater accuracy. The high-definition 3D imaging and magnification provided by the robotic system enable a clear view of the surgical field, facilitating precise repair of the refluxing valve.
Minimally Invasive Approach: Robotic surgery is minimally invasive, resulting in smaller incisions and reduced trauma to the surrounding tissues. This translates into less postoperative pain, faster recovery, and minimal scarring for children undergoing VUR repair.
Reduced Complications: The robotic system’s advanced technology and flexibility allow for precise suturing and reconstruction of the valve, minimizing the risk of complications. This is particularly important in delicate structures like the urinary tract, where precision is crucial for optimal outcomes.
Shorter Hospital Stay: Robotic surgery for VUR typically requires a shorter hospital stay compared to traditional open surgery. Children undergoing robotic VUR repair can often return to their normal activities sooner, reducing the disruption to their daily lives.
Improved Cosmetic Outcome: The small incisions used in robotic surgery result in less visible scars, leading to improved cosmetic outcomes for children. This is particularly significant in pediatric patients, as they can feel more self-confident and comfortable with their appearance after surgery.

Conclusion

Robotic surgery has transformed the management of VUR in children, offering numerous benefits over traditional surgical approaches. The precision, minimally invasive approach, and reduced complications associated with robotic surgery contribute to improved outcomes and faster recovery for young patients.
If your child has been diagnosed with Vesicoureteral reflux (VUR), consult with Dr. Geeta Kekre to understand the role of robotic surgery in managing this condition.

About Dr. Geeta Kekre

Dr. Geeta Kekre is a Paediatric Surgeon in Pune She is a specialist in pediatric minimal access surgery including robotic surgery as well as reconstructive pediatric urology. After ten years in Mumbai, Dr. Kekre returned to her hometown bringing with her a passion for the surgical care of children and a distinct set of skills in the areas of pediatric minimal access surgery, pediatric endourology, fetal hydronephrosis and antenatal parental counseling, pediatric incontinence, and voiding dysfunction. Her focus is on tailoring surgical therapy to allow her patients to have as active and fun a childhood as possible while delivering the best achievable medical outcomes.

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Minimal Access Surgery in Children

Dr. Geeta Kekre — Tue, 15 Nov 2022 06:38:51 +0000

Minimal access is the buzzword in paediatric surgery. It essentially means performing a procedure without cutting open the body wall. While the principles and the basic steps of each surgery remain the same, special instruments are used which reach the organ in question via tiny, key hole incisions or through a natural orifice. Minimal access surgery includes:

Endoscopic surgery, which is a procedure performed inside a hollow organ (eg the urethra, the urinary bladder, the stomach, the ureters, even the kidney) through an optical instrument inserted through a natural orifice such as the urethral meatus or the mouth.

Laparoscopic and thoracoscopic surgery – in this type of surgery, long, fine instruments are inserted through the body wall to reach the organ that needs surgery. The surgeon uses a fine telescope with a camera to look inside. The term laparoscopic means that the surgery is done in the abdomen while the term thoracoscopic means that the surgery is being done in the chest.

Robot assisted surgery: this is the latest advancement in minimal access surgery in children. In this type of surgery, the surgeon uses robotic arms to perform key hole surgery. The robot is completely controlled by the surgeon, and all surgical decisions are made by the surgeon. The robot overcomes the most serious limitation of laparoscopy, which is freedom of movement. Laparoscopic instruments are like long sticks which are manoeuvred by the surgeon on one end to manipulate the organ on the other end. Robotic instruments have a complex assembly of miniature pulleys and joints at the tip which allow nearly as much movement as the human wrist. This makes it easier for the surgeon to perform complex reconstructive procedures through key hole incisions.

What surgeries can be performed by minimal access?

The list of procedures that can be performed with minimal access is exhaustive. In today’s world, nearly every type of surgery has been performed with minimal access. Whether or not a patient can undergo such a procedure depends on a number of considerations. For instance, many minimal access procedures require the body cavity to be filled with a gas, usually carbon dioxide. Patients with a compromised heart or severely affected lungs may not be able to withstand this carbon dioxide. Extremely small patients such as premature infants, besides having very delicate physiology, may be physically too small to accommodate the minimal access instruments. The feasibility of removing a tumour by minimal access depends on the size, location and behaviour of the tumour. In general, a minimal access procedure takes more time to perform than an open procedure.

However, the advantages of minimal access are not insignificant. This technique minimises the scarring in the muscles of the body wall, which is advantageous in the growing child. Since the incisions are smaller, the pain and the consequent need for painkillers are greatly reduced. Although operative time increases, recovery and return to routine activities are hastened. And of course, the cosmetic outcome of a keyhole incision is much better than that of a large incision.

All in all, a patient who is a candidate for minimal-access surgery should receive one. That said, the technique should not be misused.

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