*3.1.1 Nephrectomy*

*Latest Developments in Medical Robotics Systems*

as loss of human capital, parents [70].

surgery is used most frequently in urology.

spectrum of surgical procedures in children [13].

using conventional laparoscopic surgery [11, 12].

**3. Urologic robotic surgery**

**2.5 Applications**

The primary disadvantage of robotic surgical technology in pediatric surgery is related to the size of the surgical robot and its associated instruments [4, 5, 46], the robotic instruments are only available in 2 sizes, 8 mm and 5 mm. Similarly, robotic

The cost analysis for the use of the robot is not strictly measured by numerical cost in dollars, but should be considered as value equating to quality (as defined by positive outcomes/cost). Naturally, there is the initial cost of purchasing and maintaining the robot itself, as well as the increased costs from the disposable robotic equipment and the longer operative times [4]. It should be noted other factors associated with the robotic portion of a procedure, such as increased operating room or anesthesia time, staff training, and cost of marketing campaigns [62]. In contrast, patient and parent satisfaction, as well as emotional and professional benefits, should also be considered when evaluating cost/satisfaction of this type of investment [63]. One study found that it takes at least 3 to 5 cases per week

Other cost analyses suggest that robotic surgeries are more expensive than those associated with laparoscopic or open surgery [65, 66]. However, RAS is associated with a 2% decrease in anastomotic leaks [67, 68]. This reduces hospitalization and costs of managing the resulting surgical morbidity, and benefits the earlier return of the patient to the workforce [66]. In addition, by preferably performing difficult and complex cases in which robotic surgery adds value to patient care; it should be a solution with the best profitability in hospitals that have a robotic system. In some countries such as in Latin America, costs represent a great inconvenience for the advancement of robotic surgery in children, especially in private hospitals. A short hospital stay, prudent use of instruments, reduced operating room times, and competent robotic equipment reduce costs [69]. Therefore, future comparative analyses of outcomes in children should include financial factors such

Robotic surgery has been used in almost all pediatric surgical subspecialties, including urology, general surgery (gastrointestinal-hepatopancreatobiliary), thoracic, oncology, and otorhinolaryngology. Among pediatric disciplines, robotic

The best indications for robotic surgery are procedures that require a small surgical field, fine and precise dissection, and secure intracorporeal sutures [71]. The RAS have special application in complex and reconstructive surgery, for these procedures, from the open technique; surgeons often jump to RAS [14]. RAS in otorhinolaryngology with the application of the transoral approach is particularly useful in masses of the tongue base [72]. Furthermore, RAS has performed a wide

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

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

endoscopes (lens) are currently only available as 12.0 mm and 8.5 mm.

in a program to demonstrate a net gain from robotic surgery [64].

**30**

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 staging and guiding subsequent treatment.
