Robotic-assisted urologic surgery

Mayo Clinic Children's Center is one of a few specialized centers in the United States that offer robotic-assisted urologic surgery for children. Although the minimally invasive technology was originally designed for adult surgeries, it is routinely used to treat the large number of children with complex conditions who are seen at Mayo Clinic.

"The robotic-assisted technique allows us to do a fairly complicated surgery through very small incisions," says Patricio C. Gargollo, M.D., a pediatric urologist at Mayo Clinic Children's Center in Rochester, Minnesota. "Scarring and pain are decreased because there is less tissue damage. We've found that we can minimize the hospital stays and the amount of pain medication that children take. It all translates to a faster recovery so children can return to school, and parents to work, more quickly."

At Mayo Clinic Children's Center, robotic-assisted pediatric urologic surgery is used most commonly for procedures involving kidney reconstruction or treatment of vesicoureteral reflux. "But we are also able to use it for very unique circumstances where open surgery would normally be employed," Dr. Gargollo says. "Congenital defects in the urologic tract are so varied. Robotic-assisted technology gives us another option for the unusual cases that we see at Mayo Clinic Children's Center."

The robotic-assisted technology, which is controlled by the surgeon, offers several advantages over other minimally invasive techniques. "The robotic technology has 10-times magnification and 3-D vision, unlike the 2-D field with traditional laparoscopic surgery," Dr. Gargollo says.

The technology also includes a tremor-nullifying feature to overcome distortions that can arise when surgeons make the tiny moves necessary in these procedures on small patients. Dr. Gargollo notes that surgical outcomes are comparable to traditional open surgery outcomes, in terms of success and complications.

Hidden incisions and complex simulations

Dr. Gargollo developed the hidden incision endoscopic surgery (HIdES) technique, which results in minimal scarring after kidney surgery. "We hide the incisions in the normal creases of the body — the bellybutton and an area below the bikini line. So even if a child is wearing a bathing suit, you would never see scars," he says. "When you're working on the kidney, HIdES is the only way to truly hide incisions. The instrumentation in traditional laparoscopy doesn't allow you to configure the channels you're working through in the way that hides these scars."

In addition to these groundbreaking techniques, Mayo Clinic has well-equipped simulation centers where urologists can plan complex surgeries. "Simulating these surgeries in real time is a robust tool for surgeons and also for training our research fellows and medical students," Dr. Gargollo says. To enhance planning and simulations, Mayo Clinic's 3-D printing laboratory can provide surgeons with models of a patient's anatomy.

"Mayo Clinic is unique in having these capabilities," Dr. Gargollo says. "They offer hope that pediatric patients with complex urinary conditions will have better outcomes than what was previously possible."