Robotic Surgery Applications in Pediatric Urologic Patients: Physiology and Special Considerations

For pediatric patients undergoing robotic surgery for their pediatric urologic conditions, surgeons should take into account their unique physiology and special considerations. Most pediatric minimally invasive procedures are done at lower intra-abdominal pressures (<12 mmHg) than in adult patients. Furthermore, regardless of the pressure level used, a variety of physiologic changes can occur in the pediatric cardiac, respiratory, renal, and cerebral systems. However, these physiologic changes appear reversible. While many studies of robotic surgery in children have shown favorable outcomes, it is important for the surgeon and anesthesia team to be aware of these physiologic changes so they can provide the safest environment for the pediatric patient. Special surgery-related considerations also exist in pediatric patients with the use of robotic surgery in children due to their smaller anatomy when compared to the adult population as well as the different types of urologic conditions that are surgically addressed in this patient population.