When surgery is needed, our experts at the University of Chicago Medicine Comer Children's Hospital perform robotic-assisted and minimally invasive procedures to treat a full range of pediatric urological conditions.

Robotic-assisted surgery is the newest and most exciting technique in minimally invasive surgery. Offering the precision of traditional open surgery and the shorter recovery time of minimally invasive surgery, robotic-assisted surgery is now available for intricate urological procedures for children.

How does robotic surgery work?

Comer Children's uses the da Vinci Surgical System for all robotic surgeries. During a robotic surgery, the patient is in a standard operating room fully staffed by surgeons, anesthesiologists and nurses. After making two to three tiny incisions, the surgeon positions a camera and miniature robotic surgical tools inside the patient's body. While sitting at a console just a few feet away from the patient, the surgeon uses computer controls to manipulate the instruments in the patient's body. The robotic arms function as an extension of the surgeon's hands. A video screen at the operative console gives the surgeon a clear, three-dimensional view of the surgical field.

Which urological procedures are being done robotically?

The most common urologic applications for robotic surgery are for ureteropelvic junction obstruction (UPJ), bladder augmentation, appendicovesicostomy and ureteral procedures. Robotic surgery for these and other procedures have proven to give similar results as in open surgery but with the advantage of smaller incisions and significantly shorter recovery time. As instrumentation continues to improve, more pediatric procedures will likely be performed with robotic assistance.

While robotic surgery can be used for nephrectomy, heminephrectomy and orchidopexy, laparoscopy — an operation performed with the aid of a camera through small incisions in the abdomen or pelvis — is usually sufficient for these procedures.

What are the advantages of robotic surgery?

Patients experience less pain, shorter hospital stays and faster recovery times than they do in traditional surgery. Because the surgeon operates through three to four small incisions (1/3 to 1/2-inch in size) the patient is spared the scarring and pain that is characteristic of large incisions.

Traditional minimally invasive surgeries present some technical limitations for the surgeon. Working with the robotic surgery system gives the surgeon better dexterity, precision and visibility in performing complex surgeries.

Will the robotic surgery be quick?

Robotic surgeries may take longer than other types of minimally invasive surgeries due to time needed for positioning the instruments and other equipment. Expert teams can often complete the surgery in the same amount of time as an open surgery.

How long will it take for my child to recover from surgery?

Recovery times vary from patient to patient. In general, hospitalization and recovery times for patients who have robotic surgery are much shorter than those who have an open surgery. Children often return to normal activity within a few days, compared to the several weeks necessary after an open surgery.

Is robotic surgery still in the experimental stage?

No. Robotic surgery for pediatric urology is new, but not experimental. The safety and feasibility of this procedure have been demonstrated already. Mohan S. Gundeti, MD, chief of the pediatric urology service at the University of Chicago Medicine, is one of the national leaders of robotic surgery in children. Dr. Gundeti is also an expert in all types of laparoscopic and open urologic surgery.

What if the equipment fails during the operation?

This is rare. Should something go wrong with the equipment, the surgeon can do the procedure laparoscopically or is trained to convert to open surgery.

Is robotic surgery covered by insurance?

Yes, robotic surgery is covered by insurance. Please be sure to check with your insurance provider regarding your coverage.

Many urological conditions in children can be diagnosed and treated with minimally invasive procedures, such as endoscopy and laparoscopy, performed with sophisticated, thin instruments. These procedures allow surgeons to probe and operate in very small areas of the body and save the patient the pain and scarring of a large incision.

Procedures Offered

  • Bladder and neurogenic bladder cystoplasty: Reconstruction of the bladder (enlargement of bladder with bowel)
  • Fetal urological surgery: Surgery before the fetus is born
  • Heminephrectomy/ureterectomy: Removal of part of one of the kidneys (duplex kidney) and/or removal of the ureter
  • Intersex: Removal of abnormal gonads, ovarian cyst
  • Megaureter corrections: Correction of dilated and obstructed ureter
  • Mitrofanoff appendicovesicostomy: Surgical procedure attaching the appendix to the urinary bladder to provide an outlet for urine (continent catheterizable channel)
  • Nephrectomy/nephroureterctomy: removal of one of the kidneys/ removal of a kidney and the ureter
  • Orchidopexy: Correction of undescended testis
  • Pyeloplasty: Removal of an obstruction (UPJ) and reconnection of the kidney drainage system
  • Ureteric reimplantation: Vesicoureteral reflux (VUR)
  • Varicocele treatment: Ligation of abnormal dilated veins draining the testis

Many pediatric urological diagnostic and surgical techniques can be done with minimally invasive surgery. From diagnostic endoscopy to laparoscopic and robotic surgery, these innovative procedures are done with specially designed thin instruments through tiny incisions.

Why Choose Minimally Invasive Surgery

The benefits of minimally invasive urological surgery for our young patients include:

  • Fewer complications
  • Less scarring
  • Less damage to tissue and muscle
  • Quicker return to normal activities 
  • Reduced pain
  • Reduced blood loss
  • Shorter stay in the hospital

What is endoscopy?

Endoscopy is a minimally invasive procedure that allows surgeons to inspect body organs using a probe that is inserted into natural body openings. Images from a tiny camera on the end of the probe are projected on a video screen. Endoscopy is used for diagnosing conditions of the bladder, ureter and kidneys.

What is laparoscopy?

In laparoscopic surgery, the surgeon makes two to three small (1/4 to 1/2 inch) incisions in the abdominal skin or posterior abdominal wall. These keyhole openings allow for the insertion of small surgical instruments to be placed in the abdominal cavity. A tiny camera at the tip of the instruments allows the surgeon to view the operating field. Laparoscopy is generally done under general anesthesia.

What type of minimally invasive surgery is right for my child?

Our pediatric urology team will determine the best type of surgery for your child based on your child’s thorough exam, medical history and diagnosis. Many urological conditions are now diagnosed and treated with minimally invasive techniques. Robotic-assisted surgery is typically used when a complex reconstruction such as pyeloplasty (kidney outflow obstruction), cystoplasty (bladder augmentation) or Mitrofanoff appendicovesicostomy (catheterize channel to empty bladder).

When is open surgery necessary?

Reconstruction of penile and genitalia anomalies, except intra-abdominal and impalpable testis, requires open surgery. Urologic surgery for most newborns is also done by the open approach because the small size of these patients necessitates a view of the full surgical area.

What are the complications of minimally invasive surgery?

All surgeries involve risks such as bleeding, infection and injury to nearby organs. The risk of complications with minimally invasive surgery is lower than with open surgery. Surgeons at Comer Children’s are very experienced in minimally invasive surgery for children.