St. Louis Children’s Hospital is one of only a few pediatric facilities in the country—and the only one in the St. Louis region—to offer robotic surgery for children needing urologic procedures. In most of these cases, the children experience less pain, heal faster and benefit from stronger restoration than with the standard open surgical techniques. This innovative, life-saving technology is called the da Vinci Surgical System.
Children’s is fortunate to have their own da Vinci Surgical System, as well as two pediatric urologists certified for its use. First is Washington University physician Gino Vricella, MD, a pediatric urologist who leads the robotic pediatric surgery program at Children’s Hospital. Paul Austin, MD, Washington University pediatric urologist at St. Louis Children's Hospital, is also certified for performing robotic surgery. There are several procedures that have greatly improved due to this technology.
Pyeloplasty is one of the most common urologic surgeries performed using robotic surgery at Children’s Hospital. This procedure allows doctors to clear a blockage in the kidney, also known as an ureteropelvic junction (UPJ) obstruction. During surgery, doctors reconstruct part of the kidney so that the obstruction is relieved, and urine can drain from the kidney into the bladder. Robotic surgery’s exceptional agility allows doctors to perform pyeloplasties in a time comparable to the open procedure. As a result, patients spend considerably less time under anesthesia.
Ureteral reimplantation surgery is necessary when a ureteral duplication occurs. When this happens, either one or both ureters shift in the abdomen and begin draining only one kidney. Ureteral reimplantation surgery, especially for children with reflux disease, allows for the ureters to be put back in place, so that both kidneys can be drained. Although children as young as 1 year of age can benefit from robotic surgery, ureteral reimplantation is one of the few procedures for which patients are required to be at least 4 or 5 years old. In children younger than this, the ureters are delicate and the bladder walls are thin, which increases the risk of complication.
Appendicovesicostomy (Mitrofanoff Procedure)
Our doctors have the ability to perform complex, less common procedures, like the appendicovesicostomy or Mitrofanoff procedure. This surgery benefits children who must catheterize their bladder periodically, as well as children who cannot catheterize through their own urethra. This operation allows surgeons to build a channel from the abdominal wall to the bladder, often made from the patient’s appendix, small intestine or ureter. This procedure decreases the amount of catheterization for the patient.
Currently, robotic surgery devices are geared for adults, which means those using it for pediatric procedures need to take a creative approach to performing the surgeries. The smallest instruments available for the ports used in children are 5 and 8 millimeters maximal diameter. Since children have smaller abdomens in which to work, doctors continue to develop techniques to maneuver more effectively during surgery.