Infant RA pyeloplasty- trocar placement and minimum age/weight/ measurements

[sdave]

#192

Would appreciate input on how to minimise extra corporeal clashing of the lower arm for infants. I have tried a more medial positioning, extreme burping, ipsilateral table tilt but still find restrictions in movement of the lower arm.
Also how do you decide when not to attempt a robotic assisted pyeloplasty in small infants?

[nsiddiqui]

#193

The angle of entrance of the robot with regards to the area of interest has shown to be of great importance. Animal model seems to support a 4 and 6 cm distance between ports without significant clashing on the outside.

[pgargollo]

#202

Anything less than 5 cm is going to be tough. How old are the babies you are talking about? Unless its a solitary kidney I think its safe to wait until the baby is at least 3 months not 6 months. That makes your port placement much easier not to mention that the ureter will be a bit bigger and easier to manipulate. Something to consider is this port placement (attached) where the camera is medial to the contralateral ASIS. Gives you quite a bit of room even in the small babies

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[sdave]

#204

Thank you! Have done a couple at 6 mo but apprehensive under that age group. What criteria do you use to say this is feasible robotically. This issue is that some newborns need a pyeloplasty at the 2-3 month mark and we cant delay it just to do it robotically. That would be just another MIS ding where we bend or do things differently without any justification. Will try your suggestions. Do you dock the robot differently for an infant?

[nsiddiqui]

#205

Small animal models have shown that a distance of 4 cm between ports may be feasible depending on the intra-abdominal area of interest that needs to be dissected. Also, the depth of the trocars (not at remote center necessarily) does change the intra-abdominal area of coverage reachable with the arms without clashing. We also notice that in small animal models the distance between trocars changes significantly if you measure and place the trocars with the abdomen distended by the pneumoperitoneum at different pressures and no distension at all.

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