Pediatric Urology Complications of Robotic Surgery in Pediatric Urology: A Single Institution Experience Danesh Bansal, W. Robert Defoor, Jr., Pramod P. Reddy, Eugene A. Minevich, and Paul H. Noh OBJECTIVE To report our analysis of complications on pediatric robotic urologic procedures. METHODS A retrospective review was performed for all robotic surgeries by pediatric urologists at a single pediatric institution, from the start of the robotic surgery program in February 2009 through February 2013. Data included patient demographics, intraoperative details, outcomes, and complications (Clavien system). RESULTS The analysis included 136 patients. There were 10 different types of procedures performed by 3 pediatric urologists. There were no intraoperative complications, robotic malfunctions, conversions to open or laparoscopic surgery, or mortalities. There were 11 total complications (8.1%): 2 grade I (1.5%), 7 grade II (5.1%), and 2 grade IIIb (1.5%). Complications included ileus in 2 patients (1.5%), port site infection in 2 (1.5%), urinary leak in 2 (1.5%), urinary retention in 2 (1.5%), urinary tract infection in 2 (1.5%), and stent migration in 1 (0.7%). The complication rate was in 3 of 10 infants (30%) and 8 of 126 noninfants (6.3%), P ¼ .035. However, grade I, II, and IIIb complication rates were not significantly higher in infants vs noninfants, P ¼ 1, .084, and .142, respectively. There was no difference in complication rates between the 3 surgeons. CONCLUSION Pediatric robotic urologic procedures are safely performed with a relatively low complication rate and a low incidence of additional interventions owing to complications. Ongoing use of robotic technology in the pediatric population can be supported. Further reports are needed to validate our findings. UROLOGY 82: 917e921, 2013. Ó 2013 Elsevier Inc. R obotic technology may enable surgeons to perform a wider range of minimally invasive surgery. Many advantages are espoused over conventional laparoscopy, including articulating instru- mentation with many degrees of freedom, 3-dimensional optics with depth perception, complete camera control, fine motor filtering, improved ergonomics for surgeons, and precise instrument movement. 1 In adult urologic proce- dures, robotic technology has been shown to provide defined advantages over conventional laparoscopy and open surgery. 2,3 The application of robotic surgery in pediatric urology is expanding, evidenced by increasing reports in the published data. The evolution of pediatric robotic surgery has followed increased levels of expertise and the pursuit of a goal to transfer its potential for reducing surgical morbidity to the pediatric population. Robotics has been used to perform complex reconstructive procedures in children as well. 4-7 However, questions remain as to the safety and appropriate use of this technology in children. Previous studies have documented the incidence of complications in children undergoing laparoscopic urologic surgery. 8-10 However, there are limited data regarding the incidence of urologic complications asso- ciated with robotic surgery in the pediatric population. 11 As the use of robotic technology in urology becomes more widespread, it is imperative to assess any adverse effects. The risk-to-benefit ratio in children must be carefully evaluated, because the benefits of robotics in adults may not be as readily apparent in children. In this study, we report the incidence of complications in patients under- going robotic urologic surgery in a single pediatric institution. MATERIALS AND METHODS Study Population After institutional review board approval, the medical records of all patients who underwent robotic surgery at a single pedi- atric institution were retrospectively reviewed. A total of 136 robotic surgeries were performed by 3 pediatric urologists, from the start of the robotic surgery program in February 2009 through February 2013. Infants were defined as patients younger than 12 months at surgery. Data included patient demographics, intraoperative details, outcomes, and complications. All asso- ciated intraoperative and postoperative complications were identified and graded according to the Clavien classification system. 12 Financial Disclosure: The authors declare that they have no relevant financial interests. From the Division of Pediatric Urology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Reprint requests: Paul H. Noh, M.D., Division of Pediatric Urology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229. E-mail: paulnoh@cchmc.org Submitted: April 26, 2013, accepted (with revisions): May 28, 2013 ª 2013 Elsevier Inc. 0090-4295/13/$36.00 917 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2013.05.046