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The Future of Robotic Surgery in Pediatric Urology: Upcoming Technology and Evolution Within the Field

机译：小儿泌尿外科机器人手术的未来：即将出现的技术和领域内的发展

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Since the introduction of the Da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) in 1999, the market for robot assisted laparoscopic surgery has grown with urology. The initial surgical advantage seen in adults was for robotic prostatectomy, and over time this expanded to the pediatric population with robotic pyeloplasty. The introduction of three-dimensional visualization, tremor elimination, a 4th arm, and 7-degree range of motion allowed a significant operator advantage over laparoscopy, especially for anastomotic suturing. After starting with pyeloplasty, the use of robotic technology with pediatric urology has expanded to include ureteral reimplantation and even more complex reconstructive procedures, such as enterocystoplasty, appendicovesicostomy, and bladder neck reconstruction. However, limitations of the Da Vinci Surgical Systems still exist despite its continued technological advances over multiple generations in the past 20 years. Due to the smaller pediatric market, less focus appears to have been placed on the development of the smaller 5 mm instruments. As pediatric urology continues to utilize robotic technology for minimally invasive surgery, there is hope that additional pediatric-friendly instruments and components will be developed, either by Intuitive Surgical or one of the new robotic platforms in development that are working to address many of the shortcomings of current systems. These new robotic platforms include improved haptic feedback systems, flexible scopes, easier maneuverability, and even adaptive machine learning concepts to bring robotic assisted laparoscopic surgery to the next level. In this report, we review the present and upcoming technological advances of the current Da Vinci surgical systems as well as various new robotic platforms, each offering a unique set of technological advantages. As technology progresses, the understanding of and access to these new robotic platforms will help guide pediatric urologists into the next forefront of minimally invasive surgery.
机译：自1999年引入达芬奇外科手术系统（Intuitive Surgical，Inc.，加利福尼亚州桑尼维尔）以来，随着泌尿外科的发展，机器人辅助腹腔镜手术的市场不断增长。成人最初的外科手术优势是机器人前列腺切除术，随着时间的流逝，这种优势扩展到了采用机器人肾盂成形术的儿科人群。三维可视化，震颤消除，第四臂和7度运动范围的引入使操作员比腹腔镜检查具有明显的优势，尤其是在吻合缝合中。在开始进行肾盂成形术之后，机器人技术在儿科泌尿外科的应用已经扩展到包括输尿管再植以及甚至更复杂的重建程序，例如肠囊成形术，阑尾膀胱造口术和膀胱颈重建术。然而，尽管达芬奇外科手术系统在过去20年来经历了几代人的持续技术进步，但仍然存在局限性。由于小儿科市场较小，似乎对较小的5毫米器械开发的关注较少。随着儿科泌尿外科继续将机器人技术用于微创手术，人们希望通过Intuitive Surgical或正在开发的新型机器人平台之一开发其他对儿科友好的仪器和组件，这些平台将致力于解决许多缺点当前系统。这些新的机器人平台包括改进的触觉反馈系统，灵活的范围，更容易的机动性，甚至是自适应机器学习概念，可将机器人辅助的腹腔镜手术带入一个新的水平。在本报告中，我们回顾了当前达芬奇外科手术系统以及各种新的机器人平台的当前和即将到来的技术进步，每种平台均具有独特的技术优势。随着技术的进步，对这些新型机器人平台的理解和使用将有助于引导儿科泌尿科医师进入微创手术的下一个前沿。

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