Day 2: Robotic surgery for every age and size

26 September 2017

The first ‘regular’ day of the 14th Meeting of the EAU Robotic Urology Section in Bruges offered delegates a varied scientific programme from 8AM to 6PM. In these ten hours, we saw State-of-the-Art Lectures on pressing issues of robotic urology, opportunities for hands-on-training, and the pièce de résistance of any ERUS meeting: extensive live surgery.

ERUS Chairman Prof. Alex Mottrie welcomed the delegates from behind his console in Aalst, pointing out the use of three operating theatres simultaneously, which allow a record-breaking sixteen cases to be squeezed into six sessions.

Potential for paediatric surgery
One of the morning’s presentations concerned the ways in which robotic surgical techniques are being applied to paediatric urology. Dr. Anne-Françoise Spinoit (Ghent, BE) shared her experiences in a talk that set out some of the particularities associated with treating children with robots designed for adults.

“So far, not many centres are using robotic surgical systems with child patients, perhaps four or five in Europe. There is a lot of improvisation involved, as it’s not easy to use full-size robots designed for adults on much smaller children. But I think children deserve minimally invasive technology, so that’s why we apply it anyway.”

The difficulties mainly involve the consequences of the child patients’ smaller and more fragile physique. Rather than simply being “smaller adults”, the child’s body (and organs) is still developing. There is a danger of collapsed lungs when too much insufflation pressure is applied, and the non-standard way of placing trocars, unique to every child. The newer Xi system table is not suitable for children due to its size, so urologist have to (re-)acquaint themselves with a three-armed system and much smaller cavities to operate in.

So far, there is not much support from manufacturers to customize systems or approaches for use on children, so paediatric urologist like Dr. Spinoit are blazing the trail. The major paediatric procedures that lend themselves to ‘robotisation’ are pyeloplasty or other procedures that involve a lot of suturing.

“I’m sure that paediatric robotic surgery has the potential to be practiced across Europe, and I certainly hope it will soon. The dynamic is similar to how robotic surgery was a new development some twenty years ago and it took some time to convince people. Nowadays it’s widespread and popular. Paediatric robotic surgery is only a few years behind ‘regular’ robotic surgery.”