Review – Pediatric Urology Current Use of and Indications for Robot-assisted Surgery in Paediatric Urology Ramnath Subramaniam a,b,c, * a Leeds Teaching Hospitals NHS Trust, Leeds, UK; b University of Leeds, Leeds, UK; c University of Ghent, Ghent, Belgium 1. Introduction Robot-assisted surgery (RAS) is used predominantly for reconstructive surgery in children, compared to largely extirpative surgery in adult urology [1]. Paediatric urolo- gists who are enthusiastic about RAS have driven its popu- larity, and the number and range of procedures being performed in paediatric urology with this technology are increasing. An RAS approach can overcome the challenges and advanced skill set required for reconstructive proce- dures performed via laparoscopy. 2. Challenges 2.1. Ports and instrumentation Paediatric urologists have successful in adapting the RAS technology and instrumentation primarily designed for adults. This is particularly true for port placements. The standard recommendation of 8–10 cm between ports for adults is not feasible in children for obvious reasons. There- fore, the third instrument arm is rarely of use in children, in contrast to adults, for whom it is feasible, given sufficient space, to insert an additional port. In comparison to the more diverse 8-mm instruments with cable-driven ends, the smaller 5-mm instruments have metal working ends. As a result, 5-mm instruments do not have the same effective endowrist capabilities, which limits their use [2]. Furthermore, bipolar or gyrus energy devices are only available in the 8-mm and not the 5-mm range of instruments. 2.2. Age and weight criteria While earlier reports suggested that RAS was only popular for older children [3], the lower limit is determined by E U R O P E A N U R O L O G Y F O C U S 4 ( 2 0 18 ) 6 6 2 – 6 6 4 availa ble at www.sciencedirect.com journal homepage: www.europeanurology.com/euf ocus Article info Article history: Accepted August 23, 2018 Associate Editor: Derya Tilki Keywords: Robotics Pediatric Urology Abstract The use of robot-assisted surgery (RAS) by paediatric urologists is increasing. This mini review looks at the current status of RAS in paediatric urology. The challenges involved in RAS use in children are reviewed, as well as the indications for and feasibility of procedures performed and, where possible, outcomes with RAS. Patient summary: The current status of robot-assisted surgery (RAS) in paediatric urology, together with the challenges in using RAS for children is outlined in this mini review. Innovative adaptation has pushed the boundaries as regards the feasibility of RAS procedures in children with good outcomes. © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds LS1 3EX, UK. E-mail address: r.subramaniam@leeds.ac.uk. https://doi.org/10.1016/j.euf.2018.08.020 2405-4569/© 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.