Introduction: Surgical removal of the tumor is a key step in the management of nephroblastoma. Less invasive techniques - such as robot-assisted radical nephrectomy (RARN) - have gained momentum over the past few years, but are still less frequently used in the pediatric population. This video shows our technique in case of left and right RARN in children. Methods: We present 2 cases of pediatric RARN for Wilms tumor, respectively patients of 3 and 4 years old. Both patients were treated pre-operatively with chemotherapy according to the SIOP guidelines. Repeat imaging is performed after chemotherapy as pre-operative tool to assess the feasibility of a robot-assisted approach. Under general anesthesia, in a lateral decubitus position, four robotic and one assistant port are placed. In case of right RARN an additional assistant port is placed to retract the liver. After mobilization of the colon, the ureter and gonadal vessels are subsequently identified. The renal hilum is dissected, and the renal artery and vein are divided with hem-o-lock clips. The kidney is released with sparing of the adrenal gland. The ureter and gonadal vessels are divided, and the specimen is removed through a Pfannenstiel incision. Results: Total surgical time were respectively 95 and 200 minutes, with an estimated blood loss of 5 cc. The hospital stay was limited to 3 and 4 days. Both pathological reports confirmed the diagnosis of nephroblastoma, with tumor-free surgical margins. No complications were observed 6 months postoperatively. Conclusions: This video demonstrates the robotic approach for Wilms tumors in children. Although limited series RARN for Wilms tumor is feasible in the pediatrie population. SOURCE OF Funding: Non applicable.
