**4.3 Kasai procedure**

*Latest Developments in Medical Robotics Systems*

tion due to trichobezoar [14].

tumors [110].

**4.1 Fundoplication**

difficult cases [114].

**4.2 Choledochal cyst resection**

RAS of; symptomatic bladder diverticulum excision [36], symptomatic or malignant urachal cyst excision [100], posterior urethral diverticula excision, mainly after surgical reconstruction of imperforate anus [101], prostatic utricle removal, is a malformation due to incomplete regression of Müllerian ducts [102], and varicocele cure, a condition that has a significant association with infertility [103].

**4. General surgery (gastrointestinal and hepatopancreatobiliary)**

RAS in general surgery, and thoracic surgery have not yet reached the magnitude that it has in pediatric urology. Robotic procedures that have been reported include, fundoplication, cholecystectomy, choledochal cysts resection, hepatectomy, colectomies, proctectomy with ileal pouch-anorectal anastomosis [104]. Other techniques are, Thal fundoplication and salpingo-oophorectomy [8], Soave pullthrough procedure for Hirschsprung's disease [105]. Others that are less common, RAS for the treatment of duodenal obstruction, such as the Ladd cure in intestinal malrotation, the duodenojejunostomy for superior mesenteric artery syndrome [106], the repair of congenital duodenal atresia [107], and gastroduodenal obstruc-

Hepatopancreatobiliary RAS in children inevitably involves high complexity, such as Kasai portoenterostomies and choledochal cyst resection [108–109]. Furthermore, liver resection, robot-assisted generally indicated for treatment of

Fundoplication is the most widely performed and reported robotic-assisted

When comparing conventional laparoscopic primary fundoplication and RAS in children, there were no differences between the two groups in terms of operative time, length of hospital stay, conversions, and complications. The conclusion is that RAS is a safe alternative to conventional laparoscopic surgery [111]. Regarding the advantages of RAS, a systematic review of primary fundoplication showed that postoperative complications are reduced in the robotic group. Because in the RAS there is greater dexterity and precision in the subphrenic space, than with laparoscopy [112]. In addition, RAS plays an important role in difficult cases, such as obese patients, large hiatal hernias, and redo fundoplication [113, 114]. On the other hand, with conventional laparoscopy, only skilled pediatric surgeons resolve

Choledochal cyst resection and reconstructive Roux-en-Y hepaticojejunostomy are technically complex and, only in Southeast Asian centers there is extensive experience in the laparoscopic technique. In the rest of the pediatric centers of the

In 2006, the first pediatric RAS choledochal cyst resection was reported [116]. Since that time and up to 2019, several authors have reported cohorts of 1 to 39 pediatric patients undergoing RAS choledochal cyst resection [109]. A recent publication informed 70 cases with RAS and 70 cases by conventional laparoscopy, and concluded that RAS choledochal cyst excision and hepaticojejunostomy were associated with better short-term intraoperative and postoperative outcomes, and proved the safety and feasibility of RAS in children with choledochal cysts [117].

world, most of this surgeries are performed with the open technique [115].

surgery in pediatric general and thoracic surgery [3].

**34**

The Kasai procedure can be ideal for RAS because it is a complex technique, it has an ideal instrumentation to dissect the hepatic portal and find the portal plate [118]. To date, there are very few reported cases of Kasai operation for RAS for biliary atresia. The experience is larger with conventional laparoscopy, especially in Southeast Asian countries, where the pathology is more frequent than in other latitudes of the world [115].
