Robotics Enhance Urologic Surgery at Arkansas Children's 

Embracing innovation to reduce the impact of care on patients and their families is a hallmark of Arkansas Children's. That's especially true of the urology program, which dates back more than 40 years. In the past few years alone, the program has expanded its use of telemedicine to reduce the number of in-person visits and produced atlases to educate families about what to expect following distal hypospadias repair and circumcision. The urology team is also building on its longstanding use of the da Vinci® Xi Surgical System, a technology that has transformed pediatric urologic surgery over the past 20 years. 

"We've been performing robotic cases for more than 10 years," said Ashay Patel, D.O., pediatric urologist at Arkansas Children's Hospital and associate professor in the Department of Urology at the University of Arkansas for Medical Sciences. "We've expanded our use of this technology for children in Arkansas and surrounding states to include surgery on the urinary system, the gastrointestinal system and the testicles." 

 

Wide Range of Robotic Surgical Options

Home to da Vinci Xi, the surgical system's most sophisticated multiport robotic platform, Arkansas Children's Hospital features three urologists and one pediatric surgeon who perform robotic urologic surgery. The da Vinci Xi includes a dual console, allowing two physicians to partner on operations. Other features include advanced wristed instruments, magnified, high-definition 3D visualization, and Firefly fluorescence imaging, allowing surgeons to view blood flow and other processes in real time. 

The limited space to maneuver inside patients is a major challenge in performing urologic surgery on children, according to Dr. Patel, but the enhanced maneuverability of the da Vinci robot can help alleviate it. Many children may be candidates for robotic urologic surgery, including some of the youngest patients. 

"Age and size are two of the most important factors determining a patient's candidacy for da Vinci urologic surgery," Dr. Patel said. "We typically will use the robot in children as young as 4 months, if they're big enough." 

Robotic surgeries performed by urologic surgeons at Arkansas Children’s Hospital include: 

  • Appendicovesicostomy
  • Bilateral second-stage laparoscopic orchiopexy 
  • Chait tube placement 
  • Nephrectomy 
  • Pyeloplasty 
  • Ureteral reimplantation 
  • Ureteroureterostomy 

Easing the Rigors of Surgery for Children and Families 

Urologic surgery using the da Vinci system carries a variety of benefits for surgeons and patients alike. Dr. Patel described robotic urologic surgery as "technically less demanding than pure laparoscopic procedures, and with better visualization." Compared with open surgery, robotic surgery is more ergonomic because it allows the surgeon to sit at a console with shoulders relaxed rather than hunching over the patient. 

"Patients who have robotic urologic da-Vinci surgery are discharged quicker and experience a faster recovery," Dr. Patel said. "They also enjoy improved cosmesis." 

That was the case for a teenage girl from Louisiana who, following an athletic injury, was unable to empty her bladder with a catheter independently. Dr. Patel performed a robotic appendicovesicostomy, which kept incision size to a minimum and allowed the patient to self-catheterize, thereby increasing her independence. 

In another standout case, Dr. Patel performed a robotic ureteroureterostomy on a young girl with a duplicated kidney and a ureter intruding into her vaginal area that caused urine leakage. The surgery allowed her to wear regular, age-appropriate underwear. 

At Arkansas Children's Hospital, 95% of patients who have robotic urologic surgery are discharged within 24 hours. The urology program plans to build on this success as the team continues its legacy of using robotic surgery to produce solutions for patients. 

"We provide the most up-to-date surgical experience and knowledge," Dr. Patel said. "I envision continuing to enhance the procedures we offer at Arkansas Children's Hospital." 

 

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