@article{TEXTUAL,
      recid = {5374},
      author = {Lombardo, Alyssa M. and Gundeti, Mohan S.},
      title = {Review of robot-assisted laparoscopic surgery in  management of infant congenital urology: Advances and  limitations in utilization and learning},
      journal = {International Journal of Urology},
      address = {2022-12-15},
      number = {TEXTUAL},
      abstract = {As robotic-assisted (RAL) surgery expanded to treat  pediatric congenital disease, infant anatomy and physiology  posed unique challenges that prompted adaptations to the  technology and surgical technique, which are compiled and  reviewed in this manuscript. From the beginning,  collaboration with anesthesia is critical for a safe,  efficient case including placement of an endotracheal tube  rather than a laryngeal mask (LMA) and placement of a  nasogastric tube and/or rectal tube to relieve distended  stomach or bowel, respectively. Furthermore, end-tidal  CO<sub>2</sub> (EtCO<sub>2</sub>) is important for  monitoring and predicting the effects of pneumoperitoneum  on caridiovascular physiology, incranial pressure, and risk  of acidosis and hypercarbia. Positioning can further  exacerbate these effects and affect intra-abdominal working  space. For infant robotic pyeloplasty and heminephrectomy,  a “beanbag” is commonly used for stabilization in the  lateral decubitus position. We advise against the use of a  “baby bump” because it brings the bowels and vasculature  more anterior than expected. Pnuemoperitoneum pressure of  8–10 mmHg during port placement maximizes safety, but  thereafter, the pneumoperitoneum pressure can be minimized  to 6–8 mmHg during the procedure without compromising the  visual field. Port sites should be marked after  insufflation, followed by the open Hasson technique for  peritoneal access and port placement under direct vision  with intussusception of the trocars to avoid vascular or  bowel injury. Additional tips can be obtained through this  manuscript, immersive fellowships, and mini-fellowships.  Ulitmately, infant robotic surgery has the potential to  benefit many children but is presently limited by the lack  of pediatric-specific robotic technology and its associated  costs.},
      url = {http://knowledge.uchicago.edu/record/5374},
}