Introduction: Robot-assisted surgery has been reported to provide many benefits over open surgeries to the patient and surgeon. Many surgeons experience work-related pain and musculoskeletal symptoms. Neck strain, back strain/pain and lower extremity exertion have been reported up to 20-40% of the surgeons in open surgeries. We sought to evaluate the feasibly of robotic assisted trans-vesicoscopic ureteric reimplantation in children and surgeons' work-related musculoskeletal symptoms in comparison to open surgery Methods: The children under 12 years of age with vesicoureteric reflux (VUR underwent open (Group I) and vesicoscopic robotic assisted ureteric reimplantation (VRAUR) (Group II). All surgeries were performed by a single surgeon. For VRAUR the patient was placed in a dorsal lithotomy position. Four ports (Two 8-mm working ports were placed in a straight line drawn along the anterior superior iliac spine and one endoscopic (middle) 12 mm [Intuitive Surgical, Sunnyvale, CA], was placed 2 cm above the same line and the fourth assistant port of 3 mm was placed 2 cm below the line. The surgeons related ergonomic parameters recorded in both the groups were generalised pain, neck and back strain/pain along with lower extremity exertion to surgeons (assessed as per visual analogue scale (VAS). Success was defined as the absence of VUR on direct radionuclide cystogram at 12 weeks. Results: The median age of the children was 4.5 and 5.1 in groups I and II respectively. Both the groups had 30 of patients each. The grades of VUR was comparable in both the groups. The VRAUR procedure could be accomplished in all the cases without any slippage of robotic ports or clashing of arms except in 2-year-old that without any conversion. The 2-yr-old child with bladder capacity of 150 cc posed little difficulty due to space restriction and slight clashing of arms that lengthened the procedure but could be completed successfully. The mean operative time was 95 (90-122) and140 (115-160) minutes (p=0.029) in groups I and II respectively with a successes rate of 96.7 and 93.3 (p=0.031) respectively. The Surgeons’ musculoskeletal VAS scores recorded were substantially more in Group I as compared to Group II (p value 0.03, OR 3.9 [1.9-5.4). Conclusions: Robotic assisted laparoscopic ureteral reimplantation is feasible and offers success rate comparable to open surgery. The surgical ergonomics related to musculoskeletal symptoms are more substantial in open surgery. SOURCE OF Funding: None
