在过去的数十年间，腹腔镜的出现导致了外科手术一次真正的革命，代表着外科手术思维模式的变迁，而机器人手术进一步推动了这种模式进入更高的层次。虽然机器人手术已经安全、成功地运用于成人泌尿外科的多种手术，但是它在小儿泌尿外科的应用相对较少。机器人手术系统具有良好的 3D 可视化视野、精细的运动控制操作系统和震颤过滤性能等优点，其在小儿泌尿外科实践中的潜在价值是巨大的。成人泌尿外科机器人手术技术不能照搬到小儿泌尿外科，因此充分了解机器人手术技术在小儿泌尿外科领域应用的现状及存在的问题很有必要。本文对机器人手术在小儿泌尿外科的应用现状进行总结。

In the past few decades, laparoscopy has led an revolution in surgery, it changes how and what we perform surgical procedures. While the introduction of robotic surgery systems made a further step in the evolution of surgery. Now robot surgery has evolved safely and successfully in adult urinary surgery, however, it has done so less spectacularly in pediatric urology. With three-dimensional visualized surgical field, fine operating system and good tremor filtering, it allows surgeons to perform complex surgical procedures. Great potence of robotic surgery has been showed in pediatric urology. Using a surgical robot in children does not make an adult urologist a pediatric urologist. Therefore, it is necessary to fully understand the current status and problems of robotic surgery in pediatric urology.

收稿日期：2021-01-11  录用日期：2021-04-02

Received Date: 2021-01-11  Accepted Date: 2021-04-02

基金项目：国家自然科学基金资助项目（81773094）

Foundation Item: National Natural Science Foundation of China (81773094)

通讯作者：汤绍涛，Email：tshaotao83@126.com

Corresponding Author: TANG Shaotao, Email: tshaotao83@126.com

引用格式：梅红，李聃，童强松，等 . 机器人手术在小儿泌尿外科的应用现状与展望 [J]. 机器人外科学杂志（中英文），2021，2（4）：263-271.

Citation: MEI H, LI D, TONG Q S, et al. Robot-assisted surgery in pediatric urology: current status and prospects[J]. Chinese Journal of Robotic Surgery,  2021, 2(4):263-271.

[1]Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy[J]. Endoscopy, 1976, 8(1): 33-34.

[2]Smaldone M C, Polsky E, Ricchiuti D J, et al. Advances in pediatric urologic laparoscopy[J]. Sci World J, 2007.DOI: 10.1100/tsw.2007.141.

[3]Peters C. Laparoscopy in paediatric urology: adoption of innovative technology[J]. BJU Int, 2000, 92(Suppl 1):52-57.

[4]Meininger D D, Byhahn C, Heller K, et al. Totally endoscopic Nissen fundoplication with a robotic system in a child[J]. Surg Endosc, 2001, 15(11): 1360-1361.

[5]Gettman M T, Neururer R, Bartsch G, et al. Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system[J]. Urology, 2002, 60(3): 509-513.

[6]Hubens G, Coveliers H, Balliu L, et al. A performance study comparing manual and robotically assisted aparoscopic surgery using the da Vinci system[J]. Surg Endosc, 2003, 17(10): 1595-1599.

[7]Gundeti M S, Eng M K, Reynolds W S, et al. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal—initial case report[J]. Urology,2008, 72(5): 1144-1147.

[8]Evalynn Vasquez, 谢会文 , 蒋国松 . 机器人手术在小儿泌尿外科中的应用 [J]. 临床泌尿外科杂志 , 2017,32(7): 489-499.

[9]Baek M, Silay M S, Au J K, et al. Does the use of 5 mm instruments affect the outcome of robot-assisted laparoscopic pyeloplasty in smaller working spaces? A comparative analysis of infants and older children[J]. J Pediatr Urol, 2018, 14(6): 537.e1-537.e6.

[10] Howe A, Kozel Z, Palmer L. Robotic surgery in pediatric urology[J]. Asian J Urol, 2017, 4(1): 55-67.

[11] 熊祥华 , 周辉霞 , 曹华林 , 等 . 机器人辅助腹腔镜小儿上尿路手术的体位、操作通道设计和机械臂安装应用体会 [J]. 中华泌尿外科杂志 , 2018, 39(8):

601-605.

[12] Varda B K, Wang Y, Chung B I, et al. Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015[J]. J Pediatr Urol, 2018, 14(4): 336.e1-336.e8.

[13] Bansal D, Cost N G, Bean C M, et al. Comparison of pediatric robotic-assisted laparoscopic nephrou-reterectomy and laparoendoscopic single-site nephroureterectomy[J]. Urology, 2014, 83(2): 438-442.

[14] Lee R S, Sethi A S, Passerotti C C, et al. Robot-assisted laparoscopic nephrectomy and contralateral ureteral reimplantation in children[J]. J Endourol, 2010, 24(1):123-128.

[15] Pedraza R, Palmer L, Moss V, et al. Bilateral robotic assisted laparoscopic heminephroureterectomy[J]. J Urol, 2004, 171(6 Pt 1): 2394-2395.

[16] Lee R S, Sethi A S, Passerotti C C, et al. Robot assisted laparoscopic partial nephrectomy: a viable and safe option in children[J]. J Urol, 2009, 181(2): 823-829.

[17] Mason M D, Anthony Herndon C D, Smith-Harrison L I, et al. Robotic-assisted partial nephrectomy in duplicated collecting systems in the pediatric population: Techniques and outcomes[J]. J Pediatr Urol, 2014, 10(2): 374-379.

[18] 周晓光 , 马立飞 , 陶天 , 等 . 机器人辅助腹腔镜重复肾半肾切除术治疗小儿重复肾输尿管畸形的临床分析 [J]. 中华泌尿外科杂志 , 2020, 41(7): 531-

535.

[19] Peters C A, Schlussel R N, Retik A B. Pediatric laparoscopic dismembered pyeloplasty[J]. J Urol, 1995, 153(6): 1962-1965.

[20] Minnillo B J, Cruz J A, Sayao R H, et al. Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults[J]. J Urol,2011, 185(4): 1455-1460.

[21] 吕逸清 , 谢华 , 黄轶晨 , 等 . 传统腹腔镜与机器人辅助腹腔镜技术在儿童肾盂成形术中的临床应用对比 [J]. 中华小儿外科杂志 , 2019, 40(1): 41-44.

[22] Avery D I, Herbst K W, Lendvay T S, et al. Robot-assisted laparoscopic pyeloplasty: multi-institutional experience in infants[J]. J Pediatr Urol, 2015, 11(3): 139.e1-139.e5.

[23] Cundy T P, Harling L, Hughes-Hallett A, et al. Meta-analysis of robotassisted vs conventional laparoscopicand open pyeloplasty in children[J]. BJU Int, 2014,114(4): 582-594.

[24] Riachy E, Cost N G, Defoor W R, et al. Pediatric standard and robot-assisted laparoscopic pyeloplasty:a comparative single institution study[J]. J Urol, 2013,189(1): 283-287.

[25] Khoder W Y, Waidelich R, Ghamdi A M A, et al. A prospective randomised comparison between the transperitoneal and retroperitoneoscopic approaches for robotic-assisted pyeloplasty in a single surgeon, single centre study[J]. J Robot Surg, 2018, 12(1): 131-137.

[26] Olsen L H, Rawashdeh Y F, Jorgensen T M. Pediatric robot assisted retroperitoneoscopic pyeloplasty: a 5-year experience[J]. J Urol, 2007, 178(5): 2137-2141.

[27] Lindgren B W, Hagerty J, Meyer T, et al. Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective treatment option[J]. J Urol, 2012, 188(3): 932-937.

[28] Hemal A K, Mishra S, Mukharjee S, et al. Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair[J]. Int J Urol, 2008, 15(8): 744-746.

[29] Asensio M, Gander R, Royo G F, et al. Failed pyeloplasty in children: Is robot-assisted laparoscopic reoperative repair feasible?[J]. J Pediatr Urol, 2015,11(2): 69.e1-69.e6.

[30] 谢钧韬 , 高文宗 , 李作青 , 等 . 达芬奇机器人辅助手术治疗肾盂输尿管整形术后再狭窄 [J]. 中华小儿外科杂志 , 2019, 40(9): 821-825.

[31] Ahn J J, Shapiro M E, Ellison J S, et al. Pediatric robot-assisted redo pyeloplasty with buccal mucosa graft: a novel technique[J]. Urology, 2017.DOI: 10.1016/j.urology.2016.12.036.

[32] Elder J S. Guidelines for consideration for surgical repair of vesicoureteral reflux[J]. Curr Opin Urol, 2000,10(6): 579-585.

[33] Peters C A. Robotic assisted surgery in pediatric urology[J]. Pediatr Endosurg Innov Tech, 2003, 7(4):403-413.

[34] Casale P, Patel R P, Kolon T F. Nerve sparing robotic extravesical ureteral reimplantation[J]. J Urol, 2008,179(5): 1987-1990.

[35] Kurtz M P, Leow J J, Varda B K, et al. Robotic versus open pediatric ureteral reimplantation: costs and complications from anationwide sample[J]. J Pediatr Urol, 2016, 12(6): 408.e1-408.e6.

[36] Grimsby G M, Dwyer M E, Jacobs M A, et al. Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation[J]. J Urol, 2015, 193(5 Suppl): 1791-1795.

[37] Boysen W R, Akhavan A, Ko J, et al. Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV):Outcomes and complications[J]. J Pediatr Urol, 2018,14(3): 262.e1-262.e6.

[38] Pedraza R, Weiser A, Franco I. Laparoscopic appendicovesicostomy (Mitrofanoff procedure) in a child using the da Vinci robotic system[J]. J Urol, 2004, 171(4): 1652-1653.

[39] Nguyen H T, Passerotti C C, Penna F J, et al. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population[J]. J Urol, 2009, 182(4): 1528-1534.

[40] Famakinwa O J, Rosen A M, Gundeti M S. Robot-assisted laparoscopic Mitrofanoff appendicovesicostomy technique and outcomes of extravesical and intravesical approaches[J]. Eur Urol, 2013, 64(5): 831-836.

[41] Gundeti M S, Petravick M E, Pariser J J, et al. A multi-institutional study of perioperative and functional outcomes for pediatric roboticassisted laparoscopic Mitrofanoff appendicovesicostomy[J]. J Pediatr Urol, 2016, 12(6): 386.e1-386.e5.

[42] Grimsby G M, Jacobs M A, Gargollo P C. Comparison of complications of robot-assisted laparoscopic and open appendicovesicostomy in children[J]. J Urol, 2015, 194(3): 772-776.

[43] Flood H D, Malhotra S J, O’Connell H E, et al. Long-term results and complications using augmentation cystoplasty in reconstructive urology[J]. Neurourol Urodyn, 1995, 14(4): 297-309.

[44] Schlomer B J, Saperston K, Baskin L. National trends in augmentation cystoplasty in the 2000s and factors associated with patient outcomes[J]. J Urol, 2013,190(4): 1352-1357.

[45] Murthy P, Cohn J A, Selig R B, et al. Robot-assisted laparoscopic augmentation ileocystoplasty and mitrofanoff appendicovesicostomy in children: updated interim results[J]. Eur Urol, 2015, 68(6): 1069-1075.