Robotic Surgery in Infants and Young Children: Insights from Dr. Prabhu Karunakaran
Robotic surgery is expanding the possibilities of minimally invasive treatment in pediatric urology. But when the patient is an infant, even a small procedure can require exceptional precision, careful planning, and specialized expertise.
In a recent Key Opinion Leader (KOL) interview on the MedSynapse YouTube channel, Dr. Prabhu Karunakaran, Pediatric Urologist from Hyderabad, Telangana, India, discussed the evolving role of robotic surgery in infants and young children.
The interview, “Robotic Surgery in Infants and Young Children: Challenges & Outcomes,” focuses on a particularly challenging case involving a 2.5-month-old infant weighing approximately 4–5 kg. Dr. Prabhu Karunakaran also explains the technical considerations involved in robotic surgery for low-weight children, current perspectives on outcomes, and where robotic-assisted surgery may have the greatest potential in pediatric urology.
Why Was Robotic Surgery Chosen for This Infant?
One of the key cases discussed by Dr. Prabhu Karunakaran involved an infant with Pelvi-Ureteric Junction Obstruction (PUJO), a condition affecting the drainage of urine from the kidney.
The challenge was to achieve the precision of open surgery while retaining the minimally invasive benefits of laparoscopy. Open surgery provides direct three-dimensional visualization and allows the surgeon to feel and handle tissues. However, it requires a larger incision. Laparoscopic surgery offers smaller incisions and a minimally invasive approach, but conventional laparoscopy has limitations, including two-dimensional visualization and restricted instrument movement.
According to Dr. Prabhu Karunakaran, Robotic Surgery can bring together important advantages of both approaches. It provides three-dimensional vision, magnification, stability, and articulated instruments while maintaining minimally invasive access.
For an infant, these capabilities can be particularly valuable when the surgical field and anatomical structures are extremely small.
What Makes Robotic Surgery in Infants Technically Challenging?
The smaller the child, the smaller the available working space. In the case discussed in the interview, the patient was only 2.5 months old and weighed around 4–5 kg. This makes the placement of robotic instruments and ports a critical part of surgical planning.
Dr. Prabhu Karunakaran explained that sufficient distance between the robotic ports is important to prevent the external robotic arms from colliding. He discussed approximately 6 cm of spacing as an important consideration.
Another technique mentioned in the interview is “burping” the ports, which can help create additional working space around the abdominal wall.
These technical adaptations are important, but Dr. Prabhu Karunakaran emphasized an even more fundamental factor: specialized pediatric training and experience. Robotic technology provides the tools, but the surgeon must understand pediatric anatomy and know how to operate with precision in a very limited space.
What Do We Know About Robotic Surgery Outcomes?
Parents and healthcare professionals may naturally have questions about the safety and outcomes of robotic surgery in very young children.
During the MedSynapse interview, Dr. Prabhu Karunakaran explained that available studies indicate broadly comparable outcomes between open, laparoscopic, and robotic approaches, while also noting that more research is needed.
One of the main advantages of robotic surgery is the combination of enhanced visualization and instrument control.
The three-dimensional view provides depth perception, while magnification allows the surgeon to work within a highly detailed surgical field. Articulated robotic instruments also allow precise movements at the tip of the instrument.
The interview also highlighted postoperative recovery. Dr. Prabhu Karunakaran described very low postoperative pain in his experience and noted that children can become active relatively soon after surgery. In the case discussed, the child was doing well and active within approximately 48 hours.
At the same time, Dr. Prabhu Karunakaran acknowledged that further high-quality research is needed to establish stronger comparative evidence.
Which Pediatric Urological Conditions May Benefit From Robotic Surgery?
The potential role of robotic surgery extends beyond PUJO.
During the interview, Dr. Prabhu Karunakaran discussed several pediatric urological procedures where robotic-assisted surgery may offer advantages, including:
- Pelvi-Ureteric Junction Obstruction (PUJO)
- Vesicoureteral reflux
- Bladder augmentation
- Mitrofanoff procedures
- Bladder neck surgery
- Other complex bladder procedures
- Pediatric transplantation
A recurring advantage is the ability to perform precise movements within confined anatomical spaces.
Robotic surgery may therefore be particularly useful for complex pediatric urological procedures where visualization, access, and fine instrument control are important.
However, robotic surgery is not automatically the best option for every child. The appropriate approach depends on the individual patient, the procedure, and the experience of the treating surgical team.
What Is the Future of Robotic Pediatric Urology in India?
Robotic pediatric urology is still developing in India, creating an opportunity to expand both technology and specialist expertise.
Dr. Prabhu Karunakaran highlighted the need for more pediatric urologists to develop expertise in robotic surgery. This is particularly important because pediatric robotic procedures require knowledge that goes beyond simply operating a robotic platform.
The future of robotic surgery in infants and young children will depend on bringing together advanced technology, specialized pediatric training, careful patient selection, and growing clinical experience.
As more specialists gain experience and further evidence becomes available, robotic-assisted surgery could become increasingly important in the management of selected complex pediatric urological conditions.