Patient information video: How to take care of your child after hypospadias surgery?Patient/parent education and participation helps improve post-operative care. Dressing and catheter care after hypospadias surgery varies widely and young parents are keen to use available media when seeking for help, especially if surgery is done in an outpatient setting. An information video about post-operative care after hypospadias is made available through a tertiary referral hospital's website.
Robotic partial nephrectomy for complex kidney cyst in a 4-year old boy: Points of techniqueComplex kidney cysts are rarely observed in childhood. In adult patients, when radiological studies found a suspicious renal lesion, the gold standard is surgical asportation. The robotic surgery is well known as a secure procedure for treatment these patients, and is nowadays a real alternative also for pediatric patients. The challenges in children surgery are linked to anesthesiologic gestion, smaller operative fields, the need of specific instruments and more delicate tissue handling. We present a step-by-step video description of a robotic partial nephrectomy for a renal multicystic mass in a 4 year-old child.
Urethral duplication as cause of incontinence in a 5-years-old female: Surgical approachDuplication of the urethra is a rare congenital anomaly in females which, if left unidentified, might cause refractory urinary incontinence. This video demonstrates its identification and treatment.
Three cases utilizing the Hidden Incision Endoscopic Surgery approach to port placement during penile inversion vaginoplasty utilizing a peritoneal flapYounger transgender patients undergoing penile inversion vaginoplasty (PIV) after pubertal suppression often require modified techniques to augment neovaginal tissue. Peritoneal flap vaginoplasty (PFV) is a well-established technique for improving neovaginal depth. Utilizing a Hidden Incision Endoscopic Surgery (HIdES) approach to port placement improves cosmetic outcomes of this identity-affirming procedure.
Single-port robot-assisted laparoscopic pyeloplasty in an infant: A video case report with 9 months follow upSingle-port robot-assisted laparoscopic surgery is a breakthrough in the field of minimally invasive surgery. However, it is currently only applicable to older children due to the limitation of operating space. Here, we report a case of single-port robot-assisted laparoscopic pyeloplasty (RALP) using the da Vinci Xi® surgical system in a 7-months infant.
Robotic partial nephrectomy in the pediatric population: Cumulative experience at a large pediatric hospitalRobotic partial nephrectomy is a complex minimally invasive procedure that addresses the intricate anatomy of renal masses while maximizing preservation of renal function. However, while common in adults, the evolution toward these minimally invasive procedures for children has been slow due to the anticipated technical difficulties in pediatric-sized working spaces. We present our technique and our experience with pediatric robotic partial nephrectomies that were performed with our adult urology colleagues at a large free-standing children’s hospital.
Repurposing tools: A peña stimulator as a tool to map the limits of dissection and continence zone during bladder exstrophy repairThe complete primary repair of bladder exstrophy (CPRE) aims to restore normal anatomy through complete mobilization and reapproximation of the bladder neck and proximal urethra.
The Macedo-Malone antegrade colonic enema: A minimal invasive technique that precludes appendix useAntegrade continence enema (ACE) is recommended for patients with fecal incontinence/constipation refractory to conservative management. The Malone ACE utilizes the appendix as a catheterizable channel whereas the Macedo–Malone (MM) precludes the use of the appendix. We aimed to illustrate the MM procedure.
Taking “Trans-ano-rectal” out of ASTRA: An anterior sagittal approach without splitting the rectumThe anterior sagittal trans-ano-rectal approach (ASTRA) provides excellent exposure to the urethra and vagina for partial or total urogenital sinus mobilization and subsequent reconstruction for patients with urogenital sinus anomalies. It is a frequent approach to reconstruction for children with a high confluence. However, the division of the anterior anal external sphincter and the rectal wall in the ASTRA incurs morbidity, which include fecal incontinence if one veers from the midline, and increased risk of wound infection due to fecal soilage.
Parapelvic cyst: A rare cause of ureteropelvic junction obstruction in a pediatric patient managed with robotic cyst decorticationWe report a case of a right parapelvic renal cyst causing intermittent ureteropelvic junction obstruction (UPJO).
Single-port robotic Mitrofanoff in a pediatric patientPediatric surgery began with single-incision flank surgery and has evolved to multi-port laparoscopic and robotic approaches. Recent technological advances with the single-port (SP) robot have allowed for transition back to single-incision surgery.
Development and assessment of an ex-vivo bench model aimed at laparoscopic ureteric reconstructive techniquesReconstructive and ablative urologic techniques require special technical mastery, especially the intracorporeal suturing.
A salvage procedure for redo penile prosthesis implantation in phalloplasty (De castro technique) for congenital aphalliaWe present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus.
Ultra-mini Pcnl with clear Petra® suction–evacuation access sheath and warming irrigation fluid system (Rocamed®) for stone treatment in childrenInadvertent perioperative hypothermia (a drop in core temperature to below 36 °C) occurs because of interference with normal temperature regulation by anaesthetic drugs, skin exposure for prolonged periods and the introduction of large volumes of intravenous and irrigation fluids. If the temperature of these fluids is below core body temperature, they can cause significant heat loss. Warming irrigation fluids might prevent some of this heat loss and subsequent hypothermia and that is the role of warming irrigation fluid systems.
Semi-closed-circuit vacuum-assisted MiniPCNL system in pediatric patientsSurgical treatment of kidney stones has changed over the years. The use of Mini Percutaneous Nephrolithotomy (MiniPCNL) instrumentation is associated with a reduction of major complications but it lengthens the operative time (OT). This limit may be overcome by a semi-closed-circuit vacuum-assisted MiniPCNL system, characterized by a continuous inflow and a suction-controlled outflow. We present our initial experience in pediatric patients who underwent PCNL using a 12 Fr nephroscope and a 16-Fr-large nephrostomy sheath, equipped with a lateral arm connected to suction.
Robotic assisted ileo-vaginoplasty for vaginal atresiaVaginal agenesis is a rare congenital disorder of female genital tract. Vaginal reconstruction using bowel segment is usually offered last when dilatation and/or prior vaginal reconstruction attempts using graft or flap has failed. Traditionally accomplished using open surgical approach, we describe here our initial experience of robotic-assisted ileo-vaginoplasty. The index patient presents to us with inadequate vaginal depth after failed buccal mucosal graft vaginoplasty. With the patient in low lithotomy position, port placement and docking of the robot was done.
Autologous fat grafting with stem cell transplantation in an exstrophic patient. A caseLipofilling has been used in plastic surgery for breast reconstruction and treatment of burns. Carrying out minimally invasive techniques would allow treatment of hypertrophic scars and depressed suprapubic area in exstrophic patients to improve their aesthetic appearance.
Simultaneous bilateral endoscopic surgery in a pediatric patient: Description of a NOVEL techniqueSimultaneous bilateral endoscopic surgery (SBES) is the performance of a percutaneous nephrolithotomy (PCNL) on one side and a retrograde intrarenal surgery (RIRS) on the other kidney simultaneously.
Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valveCongenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV. We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5 cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5 cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern.
Laparoscopic robotic-assisted “keel” bladder neck constructionRobotic technology has gained popularity allowing performance of several complex and difficult reconstructive procedures. This video demonstrates the advantages of the robotic approach for a “keel” bladder neck construction in an obese patient.
Laparoscopic ureteroplasty with gonadal vein graft for long ureteral stenosis: A step by step videoStrictures of the ureter may occur from iatrogenic injury or impacted kidney stones. Complications from ureteroscopy may result in ureteral stricture in 0,5–2% of patients. New techniques are being described in order to minimize the morbidity associated with classic approaches. This is a step-by-step video of this novel technique: a successful laparoscopic ureteroplasty with gonadal vein graft for a iatrogenic long ureteral stenosis. A 16 year old female patient, with multiple previous ureteroscopies for ureteral stones, presented with severe left lumbar pain.
Pneumovesicoscopic bladder tumor resection in a young boy whose urethra was too small to use a resectoscopeTo describe our experience with pneumovesicoscopic bladder tumor resection in a young boy whose urethra was too small to use a resectoscope.
Robotic-assisted excision of a prostatic utricle cyst in a 12-month boy with proximal hypospadia and 45X0/ 46XY karyotypeProstatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epididymitis.
Robot-assisted laparoscopic unroofing and fulguration of sequestered caliceal diverticula clusterWe report a rare case of four sequestered caliceal diverticula that failed previous percutaneous sclerotherapy and were subsequently managed with robot-assisted laparoscopic unroofing and fulguration of the sequestered diverticula cluster.
Prune perineum surgical correction – Treatment of a rare syndromePrune Perineum Syndrome (PPS) is rare, with only three cases described in the literature. Treatment requires abdominal and pelvic surgeries. Our goal is to provide a video with steps of the surgical corrections of this syndrome.