Minimally Invasive Techniques in Pediatric Urology: Endourology, Laparoscopy and Robotics

Description

In the last 10 years, the management of paediatric urological pathologies has been radically transformed; over 70% of all cases can now be treated with minimally invasive techniques. This book is unique in its format, because for each pathology it explores all MIS techniques available for its treatment (laparoscopy, retroperitoneoscopy, robotics, prone position, pneumovesicoscopy, endourology, laser, fetoendoscopy, etc.). Each technique is described in a dedicated chapter, which includes a video of the procedure that can be viewed online. Written by internationally renowned paediatric urology experts, the book offers a valuable toolkit for surgeons, paediatricians and urologists. Foreword Contents Part I: General 1: Laparoscopic Approach in Pediatric Urology 1.1 Introduction 1.2 Preoperative Preparation 1.3 Positioning 1.4 Instrumentation 1.5 Technique 1.5.1 Creation of Pneumoperitoneum 1.5.1.1 Closed Method Using Veress Needle 1.5.1.2 Open Hasson Method 1.5.2 Port Extraction and Emptying of Pneumoperitoneum 1.6 Postoperative Care 1.7 Results 1.8 Discussion References 2: Retropertioneoscopy Approach in Pediatric Urology 2.1 Introduction 2.2 Preoperative Preparation 2.3 Positioning 2.4 Instrumentation 2.5 Technique 2.6 Postoperative Care 2.7 Discussion References 3: Prone Approach in Pediatric Urology 3.1 Introduction 3.2 Preoperative Preparation 3.3 Positioning 3.4 Instrumentation/Room Layout/Equipment 3.5 Technique 3.5.1 Camera Port 3.5.2 Balloon Blunt Dissection 3.5.3 Working Ports 3.6 Postoperative Care 3.7 Results and Applications 3.8 Discussion References 4: Robotics in Pediatric Urology 4.1 Introduction 4.2 Procedural Evolution 4.3 System and Instrumentation 4.4 Training and Credentialing 4.5 Adoption of Robotic Surgical Practice 4.6 Setting up a Robotic Program 4.7 Application and Future Direction 4.8 Safety Net and Digital Surgery References 5: Endoscopic Approach for Urinary Tract Pathologies 5.1 Introduction 5.2 Preoperative Preparation 5.3 Positioning 5.4 Instrumentation 5.5 Technique 5.6 Postoperative Care 5.7 Results 5.8 Discussion References 6: Devices in Pediatric Endourology 6.1 Introduction 6.2 Positioning and Preoperative Preparation 6.3 Instrumentation 6.3.1 Ureteral Access Sheath/Ureteral Dilator 6.3.2 Percutaneous Nephrolithotomy 6.3.3 Endopyelotomy Balloons 6.3.4 Ureteral Stent 6.3.5 Wires 6.3.6 Baskets 6.4 Technique 6.4.1 Ureteral Access Sheath/Ureteral Dilator 6.4.2 Percutaneous Nephrolithotomy 6.5 Results 6.5.1 Ureteral Access Sheath/Ureteral Dilator 6.5.2 Percutaneous Nephrolithotomy 6.5.3 Endopyelotomy Balloon 6.6 Discussion References 7: Instruments for Pediatric MIS Urology (Laparoscopy, Endourology, Robotics) 7.1 Introduction 7.2 Endourology Instruments 7.3 Laparoscopic Instruments 7.4 Robotic Instruments References 8: Energy Sources in Pediatric MIS Urology 8.1 Basics and Biophysics of Electrosurgery 8.2 Electrosurgical Technologies 8.2.1 Monopolar Electrosurgery 8.3 Conventional and Advanced Bipolar Electrosurgery 8.3.1 Conventional Bipolar Electrosurgery 8.4 Advanced Bipolar Electrosurgery 8.5 Ultrasonic Instruments 8.6 Hybrid Technology (Bipolar + Ultrasound) 8.7 Applications in Pediatric Minimally Invasive Urological Surgery 8.8 Discussion References 9: Endoscopic Suturing in Paediatric MIS Urology 9.1 Techniques of Suturing 9.2 Suture Types 9.3 Knots Types 9.4 Instruments 9.5 Needle Delivery and Extraction 9.6 Handling a Needle 9.6.1 First Step: Needle Grasping 9.6.2 Second Step: Correcting Needle’s Position 9.7 Making a Knot 10: Pediatric Anesthesia in MIS Urology 10.1 Introduction 10.2 Preoperative Evaluation 10.3 Physiological Effect of Laparoscopy 10.3.1 Respiratory System 10.3.2 Cardiovascular System 10.3.3 Additional Systemic Effects 10.4 Anesthesia Management 10.5 Premedication 10.6 Anesthesia 10.7 Postoperative Pain, Nausea, and Vomiting 10.8 Complications 10.9 Discussion References Part II: Kidney 11: Endourologic Retrograde Balloon Dilatation of the Primary Ureteropelvic Junction Obstruction in Children 11.1 Introduction 11.2 Preoperative Preparation 11.3 Positioning 11.4 Instrumentation 11.5 Technique 11.6 Postoperative Control 11.7 Results 11.8 Discussion References 12: Robotic Pyeloplasty 12.1 Introduction 12.2 Robotic Pyeloplasty 12.2.1 Patient Positioning and Planning 12.3 Incision and Port Placement 12.4 Robot Positioning 12.5 Procedure Steps 12.5.1 Step 1: Decide upon the Best Approach to the Pelvis 12.5.2 Step 2: Establish the Clinical Problem 12.5.3 Step 3: Incise Ureter and Pelvis 12.5.4 Step 4: Anastomosis 12.5.5 Step 5: Stenting the Ureter 12.5.6 Step 6: Complete the Anastomosis 12.6 Post-Operative Actions 12.7 Conclusion References 13: Laparoscopic Approach for Uretero–Pyelo Junction Obstruction (UPJO) 13.1 Introduction 13.1.1 Preoperative Preparation 13.2 Technique 13.3 Postoperative Care 13.4 Results 13.5 Discussion References 14: Retroperitoneal Laparoscopic Pyeloplasty in Infants and Children 14.1 Introduction 14.2 Preoperative Preparation 14.3 Positioning 14.4 Instrumentation 14.5 Technique 14.6 Postoperative Care 14.7 Results 14.8 Discussion References 15: Uretero-Pelvic Junction Obstruction (UPJO) Treatment Using: One-Trocar-Assisted Pyeloplasty (OTAP) 15.1 Introduction 15.2 Surgical Technique 15.3 Complications and Follow-Up 15.4 Case Series References 16: Laparoscopic Management of Extrinsic Uretero-Pelvic Junction Obstruction (UPJO) by Crossing Vessels 16.1 Introduction 16.2 Preoperative Preparation 16.3 Positioning 16.4 Instrumentation 16.5 Technique 16.6 Postoperative Care 16.7 Results and Personal Experience 16.8 Discussion References 17: Minimally Invasive Redo-Pyeloplasty 17.1 Introduction 17.2 Preoperative Preparation 17.3 Positioning 17.3.1 For Conventional Laparoscopy 17.3.2 For Robot-Assisted Approach 17.4 Instrumentation for Conventional Laparoscopy 17.5 Instrumentation for Robot-Assisted Approach 17.6 Technical Details of Laparoscopic Redo AHP 17.7 Technical Details of Robot-Assisted Redo AHP 17.8 Postoperative Care 17.9 Discussion References 18: Nephrectomy: Robotic Approach 18.1 Introduction 18.2 Preoperative Assessment 18.3 Patient Positioning 18.4 Trocars and Instruments 18.5 Technique 18.5.1 Transperitoneal Approach 18.5.2 Retroperitoneal Approach 18.6 Postoperative Care 18.7 Results 18.8 Complications and Management 18.9 Discussion References 19: Laparoscopic Nephrectomy in Pediatric Patients 19.1 Introduction 19.2 Preoperative Preparation 19.3 Positioning 19.3.1 Patient’s Position 19.3.2 Positioning of Surgeons and Trocars 19.3.3 Pneumoperitoneum 19.4 Instruments 19.4.1 Equipment 19.5 Technique 19.6 Postoperative Care 19.7 Results 19.8 Discussion References 20: Retroperitoneal Laparoscopic Nephrectomy 20.1 Introduction 20.2 Preoperative Preparation 20.3 Positioning 20.4 Initial Access, Insufflation, and Trocar Placement 20.5 Instrumentation 20.6 Surgical Technique 20.7 Results 20.8 Discussion References 21: Posterior Prone Retroperitoneoscopic Nephrectomy 21.1 Introduction 21.2 Indications 21.3 Contraindications 21.4 Pre-Operative Preparation 21.5 Positioning 21.6 Anesthesia 21.7 Instrumentation 21.8 Technique 21.9 Postoperative Care 21.10 Complications 21.10.1 Peritoneal Tear 21.10.2 Balloon Rupture 21.10.3 Intraoperative Bleeding 21.10.4 Urine Leak 21.11 Results 21.12 Discussion References 22: Robot-Assisted Partial Nephrectomy in Children 22.1 Introduction 22.2 Preoperative Preparation 22.3 Positioning 22.4 Instrumentation 22.5 Technique 22.6 Postoperative Care 22.7 Results 22.8 Discussion References 23: Laparoscopic Partial Nephrectomy in Pediatric Patients 23.1 Introduction 23.2 Preoperative Preparation 23.3 Positioning 23.4 Instrumentation 23.5 Technique 23.6 Postoperative Care 23.7 Results 23.8 Discussion References 24: Partial Nephrectomy Using Retroperitoneoscopy 24.1 Introduction 24.2 Preoperative Preparation 24.3 Positioning 24.4 Instrumentation 24.5 Technique 24.5.1 Retroperitoneal Access 24.5.1.1 Lateral Approach 24.5.1.2 Other Techniques to Access the Retroperitoneal Space 24.5.2 Retroperitoneal Laparoscopic Upper Pole Partial Nephroureterectomy 24.5.3 Retroperitoneal Laparoscopic Lower Pole Partial Nephrectomy 24.5.4 Robot-Assisted Laparoscopic Partial Nephrectomy (RALPN) 24.6 Postoperative Care 24.7 Results and Discussion References 25: Retroperitoneoscopic Prone Partial Nephrectomies 25.1 Introduction to Retroperitoneoscopic Partial Nephrectomies 25.2 Patient Positioning 25.3 Instrumentation 25.4 Trocars Placement and Working Space Creation (Video 25.1) 25.5 Technique 25.5.1 Upper-Pole Nephrectomy (Video 25.2) 25.5.2 Lower-Pole Nephrectomy (Video 25.3) 25.6 Postoperative Course 25.7 Discussion 25.8 Prone Vs Lateral Approach 25.9 Retroperitoneoscopy: Pros and Cons References 26: Management of Kidney Stones Using RIRS 26.1 Introduction 26.2 Preoperative Preparation 26.3 Positioning 26.4 Instrumentation 26.5 Technique 26.5.1 Our Procedure Step by Step 26.6 Postoperative Care 26.7 Results 26.8 Discussion References 27: Management of Kidney Stones Using Perc/Micro-perc as Minimally Invasive Percutaneous Procedures 27.1 Introduction 27.2 Preoperative Preparation 27.3 Positioning 27.4 Instrumentation 27.5 Technique 27.5.1 Perc/Mini-perc Procedure 27.5.2 Micro-perc Procedure 27.6 Postoperative Care 27.7 Results 27.8 Discussion References 28: Place of Laparoscopic and Robotic Surgery in the Management of Kidney Urolithiasis 28.1 Introduction 28.2 Indications 28.3 Pre-Operative Preparation 28.4 Positioning 28.4.1 Non-robotic Minimal Invasive Surgery 28.4.1.1 Transperitoneal 28.4.1.2 Retroperitoneal 28.4.2 Robotic Minimal Invasive Surgery 28.5 Instrumentation 28.6 Technique (Transperitoneal) 28.6.1 Pelvic and Calyceal Stones 28.6.2 Pelvic Stone and UPJ Obstruction 28.6.3 Nephrectomy for Calculus Disease 28.7 Technique (Retroperitoneal) 28.7.1 Diverticula 28.7.2 Nephrectomy 28.8 Post-Operative Care 28.9 Results 28.10 Discussion References 29: MIS Management of Symptomatic Simple Renal Cysts 29.1 Introduction 29.2 Pre-Operative Preparation 29.3 Positioning 29.4 Instrumentation 29.5 Technique 29.5.1 Laparoscopic Technique 29.5.1.1 Laparoscopic Transperitoneal Approach 29.5.1.2 Laparoscopic Retroperitoneal Approach 29.5.2 Robot-Assisted Technique 29.6 Post-Operative Care 29.7 Results 29.8 Discussion References 30: Laparoscopic Radical Nephrectomy for Wilms’ Tumors 30.1 Introduction 30.2 Preoperative Preparation 30.3 Positioning 30.4 Instrumentation 30.5 Technique 30.6 Post-Operative Care 30.7 Complications 30.8 Results 30.9 Discussion 30.10 Conclusion References 31: Robotic Approach for Kidney Tumors in Pediatric Patients 31.1 Introduction 31.2 Pre-Operative Preparation 31.3 Nephroureterectomy (Transperitoneal Approach) 31.3.1 Positioning 31.3.2 Initial Access, Insufflation, and Trocar Placement 31.3.3 Docking with Xi System 31.3.4 Instrumentation 31.3.5 Surgical Technique 31.4 Partial Nephrectomy (Retroperitoneal Lateral Approach) 31.4.1 Positioning 31.4.2 Initial Access, Insufflation, and Trocar Placement 31.4.3 Docking with Xi System 31.4.4 Instrumentation 31.4.5 Surgical Technique 31.5 Results 31.6 Discussion References 32: MIS Management of Adrenal Tumors in Pediatric Patients 32.1 Introduction 32.2 Preoperative Preparation 32.3 Positioning 32.3.1 Positioning Depends on Surgical Approach 32.4 Instrumentation 32.5 Technique 32.6 Postoperative Care 32.7 Results 32.8 Discussion References Part III: Ureter 33: Endoscopic Treatment of Primary Obstructive Megaureter 33.1 Introduction 33.2 Pre-Operative Preparation 33.3 Positioning 33.4 Instrumentation 33.5 Technique 33.6 Postoperative Care 33.7 Results 33.8 Discussion References 34: Laparoscopic Management of the Primary Obstructive Megaureter 34.1 Introduction 34.2 Preoperative Preparation 34.3 Positioning 34.4 Instrumentation 34.5 Sutures, Tape and Stent 34.6 Surgical Technique 34.7 Evolution of the Technique 34.7.1 Postoperative Care 34.8 Results 34.9 Discussion References 35: Robot-Assisted Laparoscopic Tapered Ureteral Reimplantation (RAL-TUR) 35.1 Introduction 35.2 Preoperative Preparation 35.3 Positioning, Docking, and Port Placement 35.4 Instrumentation 35.5 Step-by-Step Technique 35.5.1 Dissection 35.5.2 Detrusorotomy 35.5.3 Trimming 35.5.4 Stenting 35.5.5 Neo-Ureterovesicostomy 35.5.6 Detrusor Wrap 35.6 Postoperative Care 35.7 Results 35.8 Discussion 35.9 Conclusion References 36: Retrocaval Ureter in Pediatric Patients 36.1 Introduction 36.2 Pre-Operative Preparation 36.3 Positioning 36.4 Instrumentation 36.5 Technique 36.6 Postoperative Care 36.7 Results 36.8 Discussion References 37: Minimally Invasive Treatment of Ureteric Stones in Children 37.1 Introduction 37.2 Preoperative Preparation 37.3 Positioning 37.4 Instrumentation 37.5 Technique 37.6 Post-Operative Care 37.7 Results 37.8 Discussion References 38: Minimally Invasive Treatment of Rare Ureteral Pathologies in Pediatric Patients 38.1 Position of the Patient 38.2 Ureteric Stenting 38.3 Ureteric Trauma 38.4 Ureteric Polyp 38.5 Congenital Ureteric Valves and Stenosis 38.6 Ureterocalicostomy for Recurrent UPJ Obstruction 38.7 Ureteroureterostomy in Duplex System 38.8 Retrieval of Migrated Double J Stent in Infants 38.9 Ureteric Substitution References Part IV: Bladder 39: Minimally Invasive Techniques in Pediatric Urology: Vesicoureteral Reflux Endoscopy 39.1 Introduction 39.2 Preprocedural Preparation 39.3 Materials 39.3.1 Implant Substances 39.4 Patient Positioning 39.5 Technique 39.6 Postprocedural Care 39.7 Results 39.8 Discussion References 40: Vesico-Ureteric Reflux (VUR): Laparoscopic Lich–Gregoir Repair 40.1 Introduction 40.2 Pre-Operative Preparation 40.3 Anaesthesia 40.4 Initial Cystoscopy 40.5 Positioning 40.6 Instrumentation 40.7 Technique 40.7.1 Ureteral Dissection 40.7.2 Detrusorotomy and Exposure of the Bladder Mucosa 40.7.3 Detrusororrhaphy 40.8 Closure 40.9 Bilateral Reimplantation 40.9.1 Postoperative Care 40.10 Results 40.11 Discussion 40.12 Conclusion References 41: Technique of Pneumovesicoscopy 41.1 Introduction 41.2 Limitations and Contraindications 41.3 Preoperative Preparation 41.4 Positioning 41.5 Instrumentation 41.6 Technique 41.7 Postoperative Care 41.8 Discussion References 42: Robot-Assisted Extravesical Ureteral Reimplantation (REVUR) for Vesico-Ureteral Reflux in Children 42.1 Introduction 42.2 Preoperative Preparation 42.3 Positioning 42.4 Instrumentation 42.5 Technique 42.6 Postoperative Care 42.7 Results 42.8 Discussion References 43: Minimally Invasive Treatment of Ureterocele 43.1 Introduction 43.2 Preoperative Preparation 43.3 Positioning 43.4 Instrumentation 43.5 Technique 43.6 Postoperative Care 43.7 Results 43.8 Discussion References 44: Minimally Invasive Treatment of Pediatric Bladder Tumors 44.1 Introduction 44.2 Types of Bladder Tumors in Children which Can Benefit from Minimally Invasive Treatment 44.2.1 Benign Lesions 44.2.1.1 Urothelial Papilloma Lesion 44.2.1.2 Fibroepithelial Polyp 44.2.1.3 Inflammatory Myofibroblastic Bladder Tumors 44.2.2 Malignant Lesions 44.2.2.1 Urachal Adenocarcinoma and Urachal Sarcoma 44.3 Symptoms 44.4 Preoperative Imaging 44.5 Treatment 44.5.1 First Step: Biopsy 44.6 Transurethral Cystoscopic Resection 44.6.1 Postoperative Care 44.7 Treatment of Urachal Remnant or Other Mesenchymal Benign Lesion 44.7.1 Positioning 44.7.2 Procedure 44.8 Discussion 44.9 Conclusion References 45: Minimally Invasive Techniques in Neurogenic Bladder 45.1 Introduction 45.1.1 Preoperative Investigations 45.1.2 Goals of Treatment 45.1.3 Conservative Treatment 45.2 Vesicoureteral Reflux in Neuropathic Bladder 45.2.1 Endoscopic Treatment of VUR in Neurogenic Bladder 45.2.1.1 Positioning and Technique of Injection 45.2.1.2 Injectable Substances 45.2.1.3 Results and Discussion 45.3 Urinary Incontinence 45.3.1 Procedures on the Detrusor 45.3.1.1 Intravesical Botulinum Toxin Therapy Material and Technique of Injection Results and Discussion 45.3.1.2 Bladder Augmentation and Appendicovesicostomy Ileocystoplasty and Continent Catheterizable Channel: Robotic-Assisted Technique (RALIMA) Preoperative Preparation Positioning Instrumentation Surgical Technique Postoperative Care Results 45.3.2 Procedures on the Urethral Sphincter and Bladder Neck 45.3.2.1 Endoscopic Injection of Bulking Agents in the Bladder Neck and Proximal Urethra Instruments and Injection Technique Results 45.3.2.2 Artificial Urethral Sphincter (AUS) Method and Surgical Technique 45.3.2.3 Periurethral Slings 45.3.2.4 Bladder Neck Reconfiguration Procedure and Surgical Technique 45.4 Conclusions References 46: Robotic Mitrofanoff Procedure 46.1 Introduction 46.2 Robotic Mitrofanoff 46.3 Patient Positioning and Planning 46.4 Incision and Port Placement 46.5 Robot Positioning 46.6 Robotic Mitrofanoff Procedure Steps 46.6.1 Step 1: Prepare the Appendix 46.6.2 Step 2: Prepare the Bladder 46.6.3 Step 3: Creating the Appendiculovesicular Anastomosis 46.6.4 Step 4: Final Intra-Abdominal Steps 46.6.5 Step 5: Creating the Skin-Lined Appendiculocutaneous Anastomosis 46.7 Post-Operative Actions 46.8 Conclusion References 47: Robotic Management of Bladder Stones in Children 47.1 Introduction 47.2 Preoperative Preparation 47.3 Positioning 47.4 Instrumentation 47.5 Technique 47.6 Postoperative Care 47.7 Results 47.8 Discussion References 48: Robotic Bladder Neck Construction for Voiding Continence 48.1 Introduction 48.2 Preoperative Preparation 48.3 Positioning 48.4 Instrumentation 48.5 Technique 48.6 Postoperative Care 48.7 Discussion References Part V: Urethra 49: Management of Posterior Urethral Valves 49.1 Introduction 49.2 Preoperative Preparation 49.3 Positioning 49.4 Instrumentation 49.5 Technique 49.6 Postoperative Care 49.7 Results 49.8 Discussion References 50: Minimally Invasive Management of Urethral Stenosis and Stricture 50.1 Introduction 50.2 Preoperative Preparation 50.3 Positioning 50.4 Instrumentation 50.5 Technique (Videos 50.3 and 50.4) 50.6 Postoperative Care 50.7 Results 50.8 Discussion References Part VI: Miscellaneous 51: Prenatal Minimally Invasive Procedures for Fetal Lower Urinary Tract Obstruction 51.1 Introduction 51.2 Epidemiology 51.3 Prenatal Diagnosis 51.4 Prognosis 51.5 Treatment 51.5.1 Rationale for Fetal Intervention 51.5.2 Treatment Based on Prenatal Classification 51.5.3 Therapeutic Options 51.6 Preoperative Preparation 51.7 Maternal and Fetal Positioning 51.8 Fetal Surgical Techniques and Instruments 51.8.1 Vesicoamniotic Shunting 51.8.2 Fetal Cystoscopy 51.8.2.1 Percutaneous Ultrasound-Guided Fetal Cystoscopy 51.8.2.2 Maternal Mini-Laparotomy-Assisted Fetal Cystoscopy 51.8.3 Serial Amnioinfusion 51.8.3.1 Percutaneous Ultrasound-Guided Amnioinfusion 51.8.3.2 Serial Amnioinfusion through Amnioport 51.9 Postoperative Care 51.10 Future Directions References 52: Robot-Assisted Laparoscopy in Differences of Sexual Development: Resection of Embryological Remnants 52.1 Introduction 52.1.1 Actual Trends in DSD Surgery 52.1.2 Background of Minimally Invasive Surgery in Children: The Robotic Platform 52.2 Indications for Minimally Invasive Surgery 52.2.1 The Utricle Cyst 52.2.2 Hemi-Uterus 52.2.3 Ectopic Kidney with Aberrant Ureter 52.3 Preoperative Preparation 52.4 Positioning 52.5 Instrumentation 52.6 Technique 52.6.1 Utricle Cyst 52.6.2 The Hemi-Uterus 52.6.3 The Ectopic Kidney with Aberrant Ureter 52.7 Postoperative Care 52.8 Results 52.8.1 Utricle Cyst 52.8.2 Hemi-Uterus 52.8.3 The Ectopic Kidney with Aberrant Ureter 52.9 Discussion 52.10 Future References 53: Laparoscopic Treatment of Prostatic Utricle in Children 53.1 Introduction 53.2 Preoperative Preparation 53.3 Positioning 53.4 Instrumentation 53.5 Technique 53.6 Postoperative Care 53.7 Results 53.8 Complications 53.9 Discussion 53.10 Conclusion References 54: Laparoscopic Treatment of Seminal Vesicle Cyst 54.1 Introduction 54.2 Preoperative Preparation 54.3 Positioning 54.4 Instrumentation 54.5 Technique 54.6 Postoperative Care 54.7 Complications 54.8 Results 54.9 Discussion 54.10 Conclusion References 55: Laparoscopic Lymphatic Sparing Palomo Varicocelectomy in Children Using Indocyanine Green (ICG) Fluorescence Lymphography 55.1 Introduction 55.2 Preoperative Preparation 55.3 Positioning 55.4 Instrumentation 55.5 Technique 55.6 Postoperative Care 55.7 Results 55.8 Discussion References 56: Management of Impalpable Testis 56.1 Introduction 56.1.1 Etiology 56.1.2 Malignancy Risk 56.1.3 Fertility 56.1.4 Other Adverse Sequelae of Cryptorchidism 56.2 Preoperative Preparation 56.3 Procedure 56.3.1 Examination under Anesthetics (EUAs) 56.3.2 Palpable Testicle 56.3.3 Impalpable Testicle 56.4 Instrumentation 56.5 Technique 56.5.1 Open Procedure 56.5.2 Laparoscopy 56.5.3 Viable Intra-Abdominal Testicle 56.5.3.1 Technique for Delivering Mobilized Testis into Scrotum 56.5.4 Nonviable Testicle 56.5.5 Alternative Techniques 56.5.6 Postoperative Care 56.6 Outcomes References 57: Application of 3D Reconstruction in Pediatric Urology 57.1 Introduction 57.2 How Does it Work? 57.2.1 The Anatomical Atlas 57.2.2 3D Virtual Model of the Patient 57.3 Prerequisite 57.4 Instrumentation 57.5 Technique 57.6 Postoperative Period 57.7 Results 57.8 Discussion References 58: Evidence Based Medicine in Minimally Invasive Pediatric Urology 58.1 Introduction 58.2 Methods 58.3 Results 58.4 Overall Outcomes in Minimally Invasive Pediatric Urology 58.5 Nephrectomy, Nephroureterectomy, and Partial Nephrectomy 58.5.1 Nonfunctioning Kidney 58.5.2 Renal Neoplasms 58.5.3 Heminephrectomy and Heminephroureterectomy for Duplex Systems 58.6 Pyeloplasty for Ureteropelvic Junction Obstruction (UPJO) 58.6.1 Laparoscopic vs. Open Pyeloplasty 58.6.2 Transperitoneal vs. Retroperitoneal Laparoscopic Pyeloplasty 58.6.3 Robotic-Assisted Laparoscopy Pyeloplasty 58.6.4 Other Techniques 58.7 MIS of the Lower Ureter 58.7.1 Vesicoureteral Reflux 58.7.2 Primary Obstructive Megaureter (POM) 58.8 Limits 58.9 Conclusion References