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.
Garrahan U-Stitch laparoscopic appendicovesicostomy – Making surgery easierAppendicovesicostomy is an established continent urinary conduit. The development of minimally invasive techniques and the reduction of operative time instigated the search for new techniques. In this video we show the laparoscopic transabdominal technique for appendicovesicostomy using U-stitch technique as proposed by Santiago Weller et al. We present a case of a teenager with neurogenic bladder and intolerance for urethral catheterization. The procedure was performed using a transperitoneal approach.
Upper lip graft (ULG) for redo urethroplasties in children. A step by step videoLower lip and cheek are commonly used sources of buccal mucosa grafts for urethroplasty. In recent years, aiming to improve the donor site morbidity, our preference changed to the use (ULG). The aim of this video is to illustrate the technical details of the ULG harvesting for children.
Robot-assisted laparoscopic diverticulectomy with ureteral reimplantationThe objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient.
The search for continence in bladder exstrophy: Bladder neck transection and Macedo catheterizable reservoir to augment the nativebladderBladder exstrophy remains one of the most challenging abnormalities in pediatric urology. We propose bladder neck transection and bladder augmentation with a catheterizeable reservoir technique to achieve continence after previous anatomic reconstruction in stages.
Phalloplasty in biological men with penile insufficiencyPhalloplasty for penile insufficiency in biological men differs from trans-men by incorporating native tissue. The study objective was to report surgical and functional outcomes of phalloplasty in biological men.
The GUD technique: Glandular urethral disassembly for distal hypospadias repairWe present an alternative procedure for distal hypospadias consisting of urethral mobilization and glandular disassembly, named GUD-technique.
Robot-assisted laparoscopic pyelotomy and ileal ureter substitution: video demonstrationWhile robot-assisted laparoscopic (RAL) ileal ureter substitution is a known treatment option for managing recurrent ureteral stricture, video documentation of this procedure is lacking. This article aims to visually demonstrate the surgical technique used in an RAL pyelotomy and ileal ureter substitution.
Cystoscopic injection sclerotherapy for bladder venous malformationsVascular malformations of the urinary bladder are rare in children and their management can be challenging. This minimally invasive approach was first described by the authors in lead 2013 and demonstrated that cystoscopic injections were safe without breech into the peritoneal cavity . Cystoscopic injection sclerotherapy can be very successful in managing the complications of bladder vascular malformations and thereby avoiding extensive surgery. This VideoBank article demonstrates the technique of cystoscopic sclerotherapy for the management of bladder venous malformations.
Single-setting robot-assisted kidney transplantation consecutive to single-port laparoscopic nephrectomy in a child and robot-assisted living-related donor nephrectomy: initial Ghent experienceKidney transplantation (KT) is the gold-standard treatment for end-stage renal disease (ESRD) in children. Robot-assisted kidney transplantation (RAKT) in adults is becoming increasingly common with potentially improved morbidity compared with open KT. The study objective was to evaluate feasibility and outcomes of RAKT in children.
Robot-assisted laparoscopic single-port pyeloplasty using the da Vinci SP® system: initial experience with a pediatric patientThe da Vinci SP® Robotic Surgical Platform (Intuitive Surgical) was recently introduced to overcome triangulation and motion restriction during laparoendoscopic single-site surgery. The authors describe a pure, single-site, robot-assisted, laparoscopic pyeloplasty (RALP) using the da Vinci SP System in a pediatric patient.
Prone posterior retroperitoneoscopic access to the kidney in children: the controlled optical trocar approachConventional access for renal surgery through the retro-peritoneum includes the blind percutaneous approach using a haemostatic clip and the Gaur balloon dissection technique or alternatively the open cut-down approach. The authors present a video detailing the technique of optical access into the retro-peritoneum.
Left lateral retroperitoneoscopic total nephrectomy of a horseshoe kidney in a 3-year-old boyThe unilateral or bilateral approach for nephrectomy in horseshoe kidney by minimally invasive surgery has been described. A total binephrectomy by a unilateral retroperitoneoscopic approach was performed for congenital nephrotic syndrome. A unilateral retroperitoneoscopic approach was planned in a 3-year-old boy (13 kg) with congenital nephrotic syndrome resistant to steroids with massive protein loss. The operative time was 160 min. The postoperative course was uneventful with continued hemodialysis until renal transplant 18 months later.
Laparoscopy-assisted ureterostomy— techniqueUrinary tract anomalies in children at times pose challenges in which immediate urinary diversion is required before definitive reconstruction. Open cutaneous ureterostomy technique is a well-established approach for this scenario. We describe the laparoscopy-assisted alternative.
Laparoscopic pediatric pyeloplasty using the Flexdex® articulating needle driver: step-by-step videoUreteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. UPJ obstruction may be treated conservatively in some cases, but surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be performed by open laparoscopic or robotic technique. The laparoscopic technique is safe and may be associated with shorter length of hospital stay and reduced complications. Lately, robotic pyeloplasty has been performed with similar results, adding the benefits of easier suturing maneuverability, but with increased costs.
Access for retroperitoneoscopic surgeryRetroperitoneoscopic surgery is used for a variety of renal and adrenal procedures in the paediatric population. This can be a challenging procedure but has advantages over open and transperitoneal laparoscopic approaches. This VideoBank article aims to aid the surgeon in gaining safe and efficient access for retroperitoneal surgery by demonstrating key steps including patient positioning and optimal trocar placement.
Reverse pedicle flap as a barrier layer for circumcised patients with megameatus hypospadiasIntact prepuce megameatus hypospadias is seen in approximately 5% of all hypospadias cases. Unfortunately, many of these children are inadvertently circumcised at birth, creating a dilemma for obtaining good barrier layer coverage at the time of surgical repair. Hill and Waxman et al. described a novel way to provide coverage in the form of a reverse pedicle flap that is presented in this video. Over the past year, 6 boys with megameatus variant hypospadias presented to the authors' service in a circumcised state.
Robot-assisted laparoscopic midureteral stricture repair and percutaneous stent placement in an infantMid-ureteral strictures in infants are a rare cause of hydronephrosis. In this surgical technique video we demonstrate a repair of a mid-ureteral stricture using a robot- assisted laparoscopic approach to mobilize and excise the stricture using the assistance of a hitch stitch as well as placement of a percutaneous stent. This technique was easily performed and successful for this patient.
Ureteral clipping for the treatment of a non-functioning upper kidney moiety associated with a massive ureterocele: step-by-step description of a novel techniqueThe objective of this video is to illustrate feasibility of the ureteral ligation for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys.
Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosisLaparoscopic transperitoneal technique for appendicovesicostomy was performed in a 5-year-old boy with a non-neurogenic neuropathic bladder using a transumbilical 5-mm port, two 3-mm working ports and a modified Shanfield anastomosis. Posterior extramucosal detrusorotomy and submucosal dissection was performed. The proximal appendix was spatulated and advanced into the bladder through a mucosal window using a U-stitch and fixed. The detrusor was then approximated creating an antirefluxing extramucosal tunnel.
Robotic excision and ureteroureterostomy of blind-ending ureteral ‘Duplication’Duplicated ureteral anatomy can be a reconstructive challenge. Blind-ending ureteral duplication has been reported with recommendations for surgical excision.
Retroperitoneoscopic lower pole heminephrectomyRetroperitoneoscopic heminephrectomy is a challenging procedure but with advantages over open and transperitoneal laparoscopic approaches. Lower pole heminephrectomy is less commonly undertaken compared with the upper pole.s
Videolaparoscopic lower pole heminephrectomy for treatment of a duplex kidneyIn a duplicated renal collecting system, or duplex kidney, the most frequent pathology presenting at the lower pole is the vesicoureteral reflux (VUR), which could lead to urinary tract infections (UTI) or even renal dysplasia. Under some circumstances, such as recurrent UTIs or impaired kidney function, heminephrectomy of the pathologic moiety is indicated. However, there are only few academic videos of laparoscopic lower pole heminephrectomy in the pediatric population available in literature.
Robot-assisted resection of ectopic kidney in children: An anatomical illustrationFailure of kidney migration during embryonic life results in an ectopic kidney, with an incidence varying from 1 in 500 to 1 in 1200. Pelvic kidney can be a rare cause of recurrent urinary tract infection (UTI), warranting nephrectomy in some cases.
Robot-assisted laparoscopic excision of prostatic utricle in a 3-year oldProstatic utricles have traditionally been excised via the open approach or laparoscopically. Recently, the robot-assisted laparoscopic approach has been described in a 19-year-old male. the case of a 3-year-old male with a disorder of sex development (mosaic 45X/46 XY), with multiple associated anomalies, who presented with recurrent UTI is presented. Renal/bladder ultrasound revealed normal bilateral kidneys, and a 4.3 × 2.8 × 3.3 cm cystic mass in the midline posterior to the bladder. Voiding cystourethrogram demonstrated a large cystic mass behind the bladder, concerning for large prostatic utricle.
Laparoscopic ureterocalicostomy in children: The technique and feasibilityUreterocalicostomy is a salvage technique commonly used for failed pyeloplasties; it has also been reported as a primary procedure in ureteropelvic junction obstruction (UPJO). This video describes the technique of laparoscopic ureterocalicostomy for primary UPJO in a child with a malrotated kidney and parenchymal thinning. A 13-year-old girl with symptomatic UPJO was found to have a malrotated kidney with a high posterior insertion of the ureter. A laparoscopic dependent ureterocalicostomy over a double-J stent was performed.