Robotic Surgery Program Updates from the Division of Pediatric Urology at UPMC Children’s

The Division of Pediatric Urology at UPMC Children’s has more than a decade of robotic-assisted surgical experience for a wide variety of indications. Since 2010, when the Division first began performing robotic-assisted surgery, more than 700 cases of pediatric urologic surgery with robotic assistance have been performed at UPMC Children's.

In March, the Division deployed the newest generation of da Vinci robotic system – the XI system – in its operating suite, upgrading its technology from the older SI model of the system.

“We have conducted more than 708 robotic cases in our Division since we first began using a robotic platform, and we have learned a tremendous amount about the advantages of the system and the indications for its use. But, perhaps more so, we have learned when robotic procedures may not be the optimal surgical path for our patients," says Glenn M. Cannon, MD, Division Chief of Pediatric Urology at UPMC Children’s. “Our long and diverse robotic surgical experience helps us to better plan our surgeries and select our patients that can benefit the most from the approach.”

Dr. Cannon and his colleague's surgical experience with the new version of the robot to date have shown a number of advantages for patients. For example, patient docking times with the new system have been greatly reduced.

“While our teams were efficient with patient docking using the previous model, we increased that efficiency greatly. This translates into further reductions in operating time which directly benefits the patient in a number of ways, for example, in anesthesia exposure time, but the decrease in docking time helps reduce surgical cost since the biggest driver of that metric is the length of the procedure,” says Dr. Cannon.

The optical quality of the new system is improved with stereoscopic optics providing greater clarity and resolution in the visual field in three dimensions. Instrumentation afforded by the new system includes devices to seal blood vessels more efficiently in procedures with a higher risk of blood loss.

"The youngest patient we have used the new system on to date was six months of age," says Dr. Cannon. "What we are trying to evaluate and plan for now is optimal port placements and incisions for patients of different ages because of the increased flexibility available to us. Moreover, while we cannot use the smallest 5mm instruments with the new device, the difference in our experience so far is negligible, even with the smallest of patients."

Learnings and Future Directions of Robotic Surgery in Pediatric Urology

One of the challenges of performing robotic surgery in pediatric patients is that the systems are designed for adult patients and adapted for use in children. While this is not optimal – children are not just small adults; you cannot treat them as such medically or surgically- as the saying goes, with study and skill, pediatric urologic surgeons at UPMC Children’s have proven that patients can and do benefit from the technology when used with discrimination.

"When we first began robotic-assisted surgeries more than a decade ago, our initial thoughts were that we could apply this technology to virtually any case or indication, but our experience has taught us that is not the case. We choose our cases with those learnings in mind. When we think robotic approaches are the best method for our patients, we pursue them, and they reap the benefits – minimally invasive, smaller incisions, in some cases shorter procedures," says Dr. Cannon.

Comparative Studies and Long-Term Case Evaluations

Dr. Cannon is currently tracking surgical metrics on cases performed using the newest generation of the robot to run longitudinal comparative analyses against prior experience to ensure that key performance metrics such as patient docking time and total surgical case times remain stable and improve.

"The goal is to ensure that our quality level remains high and improves, which we think it will as our preliminary case experience has shown and as our total volume increases over the coming years working with the new robotic device," says Dr. Cannon.