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Over the last two decades, we have seen a significant paradigm shift for the treatment of ureteropelvic junction (UPJ) obstruction. While initially the only treatment option was an open surgical approach, the decades have shown an evolution towards less invasive therapies. The move towards minimally invasive surgery was attributed to the significant morbidity associated with an open flank incision. This has led to the growth of laparoscopic and endoluminal surgical options that provide the potential for decreased morbidity: less blood loss, less pain, shorter hospitalizations, and faster recovery.

The technique of robot-assisted radical cystectomy (RRC) allows precise and rapid removal of the bladder with minimal blood loss, which is translated in to minimal morbidity with equivalent success to open surgery to the patient. Herein, we briefly describe this new technique of robotic radical cystectomy and urinary diversion with review of the published literature. The potential advantages of robot-assisted surgery can be transferred in complex and advanced urooncologic surgery such as bladder surgery. However, long-term oncological and functional outcome are yet awaited.

Robotic surgery has rapidly progressed into the mainstream of modern surgical practice. The da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) has been particularly embraced by the urologic community. Some of the urologic applications include pyeloplasty, cystectomy with diversion, adrenalectomy, pelvic floor reconstruction, nephrectomy, and partial nephrectomy. However, the robotic system’s largest impact has been in its use for radical prostatectomy. It has been calculated that in 2005, 20% of all radical prostatectomies performed in the United States are performed using a robotic platform, and that number is projected to grow significantly. International usage is also gaining increased acceptance.

The availability of practical, clinically approved robotic surgical assist systems for laparoscopy, the da Vinci® (Intuitive Surgical Inc., Sunnyvale, CA) and Zeus® (Computer Motion, Santa Barbara, CA) systems, opened a door that was only ajar for reconstructive laparoscopy in pediatric urology. The technology is novel and expensive, yet the initial results and experience justify an enthusiastic continuance of its development and application in pediatric surgicalpractice. With increasing familiarity with its potential, its applications have broadened to more than a dozen types of procedures. This chapter will review the current use of robotic-assisted procedures in pediatric urological practice, and provide an early assessment of the strengths and limitations and speculation as to the future directions.

Surgery in the field of reproduction has traditionally been taught utilizing tradition laparotomy incision. The advantages of the laparotomy approach include depth perception and tactile feedback from the resistance of tissue/organ dynamics. In addition, there is an ease of intraabdominal suturing from the six degrees of freedom afforded from the human wrist. Although a laparotomy is advantageous for the surgeon compared to other surgical techniques, there are disadvantages for the patient, including a large abdominal incision, prolonged hospitalization, increased postoperative analgesic requirements, and increased morbidity. This has led some surgeons to seek out minimally invasive approaches. The first laparoscopy was described by Ott from Petrograd, who inspected the abdominal cavity using a head mirror and an abdominal wall speculum in 1901, calling the procedure . However, it was the first International Symposium of Gynecologic Endoscopy in 1964 that initiated interest in laparoscopic tubal sterilization, gamete intrafallopian tubal transfer, and other laparoscopic gynecologic procedures in the ensuing four decades.

To date, there has been limited research and reporting in obstetric, gynecological, and female urology literature concerning the use of robotics. Robotics has been utilized only for the treatment of two benign gynecologic conditions: benign hysterectomy and sacrocolpopexy, which is a treatment for posthysterectomy vaginal vault prolapse (VVP). However, laparoscopy has been utilized extensively in gynecologic surgeries and has demonstrated itself to be invaluable with procedures such as total and supracervical hysterectomies and for the evaluation and treatment of endometriosis. More recently, laparoscopy has been reported for staging purposes of gynecologic malignancies, for the treatment of early stage endometrial cancer, and the treatment of ectopic pregnancies.

The confluence of minimally invasive surgery, integrated operating rooms, and telerobotic surgery promises substantial advances for all types of surgery in the 21st century. Laparoscopic approaches to minimally invasive surgery have won dramatic gains for patients in terms of short-term outcomes. Integrated laparoscopic operating rooms insert teleconferencing capabilities into surgical suites and offer easy access to telementoring for inexperienced surgeons during the steep learning curves of many advanced minimally invasive surgical procedures. The rapid evolution of robot-assisted surgery into telerobotic surgery provides technologic solutions to many of the inherent limitations of laparoscopic surgery. Moreover, the surgeon’s console of telerobotic surgical systems provides a platform for integration in novel formats of the varied forms of digital information currently generated for surgical patients.