**3. Urologic robotic surgery**

To date, the application of MIS in pediatric urology has evolved over more than 30 years [73]. Urology has the highest acceptance of robotic surgery within pediatrics. The first use of robotics in children was a pyeloplasty for ureteropelvic junction (UPJ) obstruction, because the ureteropelvic anastomosis was a technical challenge using conventional laparoscopic surgery [11, 12].

In a systematic bibliographic search that was carried out of all the published cases of pediatric robot-assisted urological surgery between 2003 and 2016. A total

**31**

*Robotic-Assisted Minimally Invasive Surgery in Children DOI: http://dx.doi.org/10.5772/intechopen.96684*

tract and iii. Miscellaneous procedures.

staging and guiding subsequent treatment.

*3.1.2 Partial nephrectomy*

and redocked [75].

for the treatment of UPJ obstruction.

nal drainage was used in the surgical bed.

*3.1.3 Pyeloplasty*

**3.1 RAS on the upper urinary tract**

*3.1.1 Nephrectomy*

of 151 publications that reported 3688 procedures in 3372 patients were identified. The most reported procedures were pyeloplasty (1923), ureteral reimplantation (1120), heminephrectomy (136), and nephrectomy or nephroureterectomy (117). There were 16 countries and 48 institutions represented in this literature [6]. We will approach the surgical urological pathology of the child based on the anatomy of the urinary tract as follows, i. Upper urinary tract, ii. Lower urinary

In pediatric patients, complete or partial nephrectomies are indicated more frequently for benign diseases and less frequently for malignant diseases. Indications for RAS nephrectomy for benign diseases are multicystic dysplastic kidney disease, kidney exclusion due to various pathologies, such as UPJ obstruction, reflux nephropathy, among others, indications of malignant tumors, particularly Wilms tumor are increasing legitimizing itself through corresponding treatment protocols, and surgery performed while adhering strictly to oncological surgical rules [74]. In nephrectomy, the initial step is the dissection and exposure of the renal pedicle, its ligation and cutting. The next step, the kidney is completely freed from its surrounding tissue. Subsequently, the dissection of the ureter is performed, in the case of radical nephroureterectomy it should be performed up to the bladder. The kidney is extracted through the umbilical access, in case of nephrectomy due to tumor, the use of a collection bag is mandatory, and it is removed through a Pfannenstiel incision, and finally lymph node sampling is crucial for surgical

Ureteral duplication is the most common congenital abnormality of the urinary tract. Partial nephrectomy for benign indication is performed for the resection of a deficient or non-functional fraction of a duplex system and can cause or be associated with obstruction and hydronephrosis, dysplasia, megaureter, ureterocele, and vesicoureteral reflux. Heminephroureterectomy is performed in cases with a reflux system [73]. It is recommended before surgery, to place a stent in the ureter to be preserved (for easy identification during dissection). If the ureter of the remaining fraction is to be reimplanted or if an ectopic ureter is to be followed in the deep pelvis, the robot is repositioned between the patient's legs

Robot-assisted pyeloplasty is the most common procedure performed robotically in pediatric patients, both within urology and overall [76]. The excellent experience with robot-assisted pyeloplasty has challenged other approaches as a new standard

Dismembered pyeloplasty (Anderson-Hynes) includes resection of the UPJ and reduction of the renal pelvis. In the technique, the ureter is incised and spatulated laterally to provide sufficient ureteral wall length to achieve a wide side-to-side anastomosis. Once the anterior layer of the pelvic-ureteral anastomosis has been sutured, an antegrade transanastomotic double-J stent is passed. J-Vac transabdomiof 151 publications that reported 3688 procedures in 3372 patients were identified. The most reported procedures were pyeloplasty (1923), ureteral reimplantation (1120), heminephrectomy (136), and nephrectomy or nephroureterectomy (117). There were 16 countries and 48 institutions represented in this literature [6].

We will approach the surgical urological pathology of the child based on the anatomy of the urinary tract as follows, i. Upper urinary tract, ii. Lower urinary tract and iii. Miscellaneous procedures.
