Paediatric oncology surgeons play a crucial role in diagnosing, staging, and treating malignant solid tumors. In recent years, many solid tumour protocols have advocated for a more tailored surgical approach to both the primary tumour site and metastatic disease. The integration of Minimally Invasive Surgery (MIS) into paediatric oncology practice has gained popularity over the past few decades. While the benefits of MIS are well established in non-oncologic surgery, its role in paediatric solid tumours is still evolving and, in many cases, lacks high-quality evidence. These IPSO-MIS guidelines guidelines aim to provide practical surgical recommendations for diverse clinical scenarios, addressing the needs of both High-Income Countries (HICs) and Low- and Middle-Income Countries (LMICs). The contributing authors represent both settings, ensuring a comprehensive and inclusive perspective. We hope that these guidelines will contribute to improving outcomes for children with cancer worldwide. Israel Fernandez-Pineda, IPSO Education Committee Chair Abdelhafeez H Abdelhafeez, IPSO Education Committee Member.

OBJECTIVE:The impact of prenatal diagnosis timing in posterior urethral valves is unclear. We aimed to compare renal function between patients with suspected PUV diagnosed before or after 28 weeks of gestation in a population who underwent systematic T2 and T3 ultrasounds. METHODS:We performed a retrospective analysis of a prospective cohort of patients with prenatally suspected and postnatally confirmed PUV. Patients were stratified by timing of prenatal ultrasound detection of urinary tract abnormalities (T2 vs T3). We compared nadir creatinine and mid-term eGFR (> 5 years of follow-up). RESULTS:72 boys with postnatally confirmed PUV were included. Thirty-seven patients (51%) were diagnosed before 28 weeks' gestation (T2 group). This early group had significantly higher NC values (median 38 vs. 26 μmol/L, p < 0.05) and lower eGFR at mid-term follow-up (median 85 vs. 105 mL/min/1.73 m2, p < 0.05) compared to the T3 group. CONCLUSIONS:PUV suspected during the second trimester of gestation is associated with significantly worse NC and mid-term renal function compared with those suspected later in pregnancy (T3). Reports of prenatal diagnosis of PUV should dichotomize between T2 and T3 diagnoses. The true rate of PUV that could be diagnosed prenatally is higher than expected.

Introduction The application of robotic-assisted surgery to Ladd's procedure in children has expanded in recent years, raising technical considerations regarding patient positioning and trocar placement. Case presentation A 5-year-old boy with a history of intermittent abdominal pain presented with acute symptoms; imaging revealed intestinal malrotation with a high-positioned cecum, inversion of the mesenteric vessels, and a shortened mesenteric base. A robotic-assisted Ladd's procedure was performed: an 8mm trocar was placed at the umbilicus, while three additional 8mm trocars were inserted through suprapubic incisions along the Pfannenstiel line - one to the left of the midline, one at the midline, and one to the right. The central suprapubic trocar was used as the camera port, the lateral trocars served as robotic working arms, and the umbilical port was used as an accessory trocar. Intraoperatively, Ladd's bands were divided using monopolar curved scissors. The mesenteric root was broadened with the aid of the instrument. After the gastrocolic ligament was sectioned using a vessel sealer, the cecum was transferred to the left iliac fossa to complete the repositioning. The presented technique offered excellent exposure of the entire mesenteric root and optimal visualization of both upper and lower quadrants without the need for redocking. No appendectomy was performed at the surgeon's discretion, as current guidelines do not mandate it and available evidence does not demonstrate a benefit from its routine removal. There were no intraoperative complications. Operative time was 120 minutes, with a docking time of 22 minutes. A nasogastric tube was left in place for the first 24 hours. Enteral feeding was resumed progressively, and the patient was discharged on postoperative day 3. Follow-up at one year was unremarkable. Conclusion Robotic-assisted laparoscopic Ladd's procedure placing the ports along the Pfannenstiel line seems to be a safe and effective approach for the elective management of intestinal malrotation in children.

Background Prune Belly Syndrome (PBS) is a rare congenital disorder characterized by bilateral intraabdominal undescended testes, abdominal wall flaccidity, and urinary tract dilation. Surgical management of cryptorchidism in PBS is technically challenging due to anatomical and urological anomalies. This study aimed to evaluate outcomes of different orchidopexy techniques, laparoscopic vs. open and one-stage vs. two-stage, in a national multicenter PBS cohort over 30 years. Methods We retrospectively reviewed 56 PBS patients treated between 1990 and 2023 in 22 French centers using data from the MARVU National Registry. Testicular position and size at last follow-up were compared across surgical techniques and staging approaches. Results A total of 87 orchidopexies were performed at a median age of 22 months; 62 (71%) were one-stage and 25 (29%) two-stage. Laparoscopy was used in 25 procedures (29%), more frequently in recent years. At a median follow-up of 7.5 years, 66 testes (76%) were located intrascrotally and 68 (79%) were of normal size. Testicular atrophy was observed in 15 cases (17%) and ectopic positioning in 18 (21%). No significant differences were found in anatomical outcomes based on surgical approach (intrascrotal position: 88% laparoscopic vs. 71% open, p = 0.11) or staging (atrophy: 19% one-stage vs. 12% two-stage, p = 0.54). Limitations include retrospective design and lack of hormonal or fertility data. Conclusions Both one-and two-stage orchidopexies, whether laparoscopic or open, provide comparable anatomical outcomes in PBS-related cryptorchidism. Technique selection should be individualized. Prospective studies are needed to evaluate long-term endocrine and reproductive function.

Minimally invasive surgery (MIS) has become a cornerstone in many areas of pediatric surgery, with proven benefits including reduced postoperative pain, shorter hospitalization, faster return to normal activity, and improved cosmesis. In pediatric surgical oncology, however, the application of MIS has historically been limited by concerns about compromising oncologic principles, the technical challenges posed by small anatomy, and the lack of robust data compared to adult series. Over the past 2 decades, advances in technology, perioperative care, and collaborative research have led to a gradual expansion of indications for MIS in children with solid tumors.

This study explores implementation of robotic surgery in children emphasising the critical role of data informatics. Development of purpose-built multi-centre databases and collaborative prospective studies will facilitate ongoing expansion, establishment of a robust evidence-base, and ultimately enhance surgical outcomes.This study explores implementation of robotic surgery in children emphasising the critical role of data informatics. Development of purpose-built multi-centre databases and collaborative prospective studies will facilitate ongoing expansion, establishment of a robust evidence-base, and ultimately enhance surgical outcomes. To explore the integration of evidence-based medicine (EBM) in guiding the expansion of paediatric robotic surgery and the establishment of robust clinical databases for informed practice. We conducted interviews with leading experts in paediatric robotic surgery—Prof. Thomas Blanc, Prof. Mohan Gundeti, and Prof. Craig Peters. Their insights were synthesised to develop a database framework, which will serve dual purposes: quality assurance and facilitating research initiatives. Various data management platforms were evaluated, including Microsoft Excel, Research Electronic Data Capture (REDCap), as well as custom-built solutions, each demonstrating distinct advantages in usability, accessibility, security, and cost-effectiveness. Data points were identified through review of extensive clinical experience, collaborative brainstorming sessions and forward-thinking strategies. Based on expert consultation, a suggested REDCap database was developed for future use. The interviewed experts unanimously emphasised the importance of dedicated personnel and shared objectives in ensuring the future-proofing, sustainability and overall effectiveness of clinical research databases. This study highlights the imperative for interdisciplinary collaboration and institution of data informatics at the point of establishment of paediatric robotic programs.

PURPOSE:This study evaluates a 27-year single-center experience with continent catheterisable channels (CCC) to identify factors influencing long-term outcomes. METHODS:Retrospective review (1998-2025) conducted on patients undergoing CCC placement. Data points analyzed included primary diagnosis, surgical indication, conduit type, stoma location, and postoperative complications. RESULTS:The study included 175 children (99 males) with a total of 178 CCC procedures performed. Primary diagnoses included neuropathic bladder (53%), exstrophy-epispadias complex (21%), complex uropathy (12%), cloacal malformations (7%), and posterior urethral valves (7%). Median age at surgery was 11.3 years (IQR 7.8-14.7). Indications for CCC were concomitant bladder-outlet or reconstructive surgery (46%), difficult urethral catheterization (27%), desire for improved autonomy (21%), and redo surgery (3%). Conduits utilised were appendix (78%), ileum-Casale (9.6%), ileum-Monti (8.4%), and other - sigmoid, vesical flap, ureter (4%). Stoma sites included the right iliac fossa (51%), umbilicus (42%), and other locations (7%). At a median follow-up of 9 years (IQR 4-12), 97% of children maintained channel utility. Complications occurred in 28% of children (n=48), totalling 70 events: superficial stenosis (9%), suprafascial obstruction (10.7%), subfascial obstruction (7.3%), stomal incontinence (6.2%), and complete channel loss (6.2%). The use of the appendix was associated with lower complication rates (p=0.03). Stoma location did not significantly impact complication rates. CONCLUSIONS:Continent catheterisable channels provides durable long-term benefits with high patient utilisation rates. Use of the appendix as a conduit is associated with superior outcomes and fewer complications. Stoma location does not significantly impact complication rates; therefore, site selection should be individualized.

OBJECTIVES:Thoracoscopy is the gold standard for paediatric lung surgery. However, in patients with prior infections or inflammatory lung disease, conversion rate to open surgery remains high. Optimized technical skills with robotic-assisted thoracic surgery (RATS) may offer technical advantages in complex cases. METHODS:This retrospective multicentre study assessed safety and outcomes of RATS for anatomical lung resection in paediatric patients. We retrospectively collected data from all the French university hospital using robotic platform for lung surgery between 2016 and 2024. The procedures were conducted in collaboration with robotic adult thoracic surgeons. RESULTS:During the study period, 687 lung resections were performed in the 3 participating centres. Among them, 30 underwent RATS lung resection, with a median age of 10 years [8.3-13.0] and a median weight of 32.5 kilograms (kg) [27.3-48.8]. No intraoperative complications or conversions to thoracotomy occurred. The overall postoperative complication rate was 33%, consisting mostly of minor air leaks and pleural effusions that resolved spontaneously. Severe complications (Clavien-Dindo ≥ III) occurred in 10% of cases. Median hospital stay was 5 days. Despite a predominance of chronic inflammatory lung disease and previous infections (conditions typically associated with higher morbidity), the robotic approach maintained acceptable outcomes. Within those patients, 3 bronchial sleeves were successfully performed. CONCLUSIONS:Robotic-assisted thoracic surgery appears to be a feasible and safe alternative to thoracotomy for paediatric lung resection especially for complex cases. Its enhanced dexterity and 3-dimensional visualization facilitate complex dissections and suturing, particularly in inflammatory conditions. The rarity of indications and the limited operative workspace in this population remain challenges, encouraging collaboration with high-volume adult robotic thoracic surgeons.

Solitary functioning kidney (SFK) is linked to chronic kidney disease (CKD) in children, particularly when associated with congenital anomalies of the kidney and urinary tract (CAKUT). Pelvi-ureteric junction obstruction (PUJO) is the most frequent obstructive uropathy in SFK. This study aimed to evaluate long-term kidney function in children operated on for PUJO in an SFK. Among a retrospective cohort study of children with an SFK, a subgroup analysis was performed: primary SFK with operated PUJO ( n  = 35); primary SFK without CAKUT ( n  = 108); primary SFK with CAKUT other than PUJO ( n  = 24). Markers of CKD and measured glomerular filtration rate were assessed during follow-up. Surgery was indicated because of neonatal acute kidney injury (AKI) ( n  = 21), worsening renal pelvis dilation ( n  = 10). The median age at surgery was 15 months (1.2–30 months). At a median age of 13 years at last follow-up, the proportion of CKD was higher in primary SFK with PUJO compared to primary SFK without CAKUT (43% vs. 12%, p  = 0.0008). In SFK/PUJO, neonatal AKI was predictive of subsequent CKD (OR 4.8, p  = 0.04). PUJO in an SFK is associated with a high rate of CKD during childhood, particularly when neonatal AKI is present.

This paper presents a novel approach for digital twin applications in surgical planning, integrating a differentiable simulator for trajectory generation within segmented medical images and a virtual reality (VR) platform for navigating an overlay of medical images and generated trajectories. The first section of this study delineates a path-planning method utilizing Langevin random walkers subjected to both local and non-local trajectory constraints. This stochastic process effectively navigates the complex topography of medical imaging data without necessitating comprehensive surgical instrument modeling or replicating the environment's physical properties. The second section introduces a custom-developed shader that seamlessly integrates raw and segmented medical images with potential surgical trajectories within a VR environment. This VR integration provides surgeons an immersive and intuitive platform, facilitating interactive exploration and selecting optimal surgical paths. The system extends beyond predefined trajectory generation criteria, allowing real-time adjustments based on the surgeon's expertise and situational assessment. The approach combines these advanced computational techniques with state-of-the-art visualization methods to enhance surgical planning precision and efficiency. This integrated digital twin strategy can potentially improve preoperative decision-making significantly and, consequently, surgical outcomes.

INTRODUCTION:Adrenocorticotrophic hormone (ACTH)-independent Cushing's syndrome (CS) is a rare cause of pediatric CS. Our objective was to describe the features of pediatric ACTH-independent CS and to compare groups defined by etiology. METHODS:We conducted a retrospective observational study of patients aged 0-18 years at diagnosis between 1992 and 2022 for ACTH-independent CS in three Paris pediatric hospitals. Additionally, we compared the outcomes of McCune-Albright syndrome (MCAS) patients with CS and without CS. RESULTS:Of the 15 patients with CS, 7 had MCAS, 7 had primary pigmented nodular adrenocortical disease (PPNAD) as part of CNC (Carney complex), and 1 had CS with no etiology found. Age at CS diagnosis was 0.3 years old (0.17; 1) in MCAS and 9 years old (5; 15) in PPNAD. The MCAS group had more impaired growth retardation (-4.75 SDS in MCAS vs. -1 SDS in CNC, p = 0.006) and higher prevalences of intrauterine growth retardation (p = 0.01) and liver dysfunction at diagnosis (p = 0.04). All 7 MCAS patients had learning disabilities vs. only 2 CNC patients. 12 out of 15 had bilateral adrenalectomy. None of the MCAS patients received growth hormone therapy, while 4 CNC patients benefited from growth hormone therapy. At the end of follow-up, growth recovered in both groups, albeit less in the MCAS group (-1.5 SDS in MCAS vs. -0.5 SDS in CNC), in which liver dysfunction often persisted. CONCLUSION:ACTH-independent CS is rare but can lead to significant burden in children. Early diagnosis and management are essential. New drugs targeting adrenal steroid synthesis are awaited.

Posterior urethral valves (PUV) are congenital anomalies characterized by the persistence of mucosal folds in the urethra, leading to various degrees of obstruction. They are the most common cause of lower urinary tract obstruction in fetuses and children, with a severe prognosis, as one-third of affected children develop end-stage renal disease before adulthood. The French National Diagnostic and Care Protocol (NDCP) aim to provide healthcare professionals with guidelines for the optimal diagnostic and therapeutic management of PUV from the fetal stage to adolescence. The guidelines emphasize early diagnosis through prenatal ultrasound and the importance of a multidisciplinary approach involving pediatric urologists, nephrologists, and other specialists. It outlines prenatal interventions such as vesico-amniotic shunting and postnatal surgical options like endoscopic valve ablation to alleviate obstruction and preserve renal function. Long-term follow-up is crucial for monitoring renal function, managing bladder dysfunction, and preventing complications such as urinary tract infections and chronic kidney disease. The guidelines also identify off-label pharmaceuticals and necessary specialty products not typically covered by insurance. By standardizing care pathways and promoting consistent, high-quality care, the guidelines aim to improve the prognosis and quality of life for children with PUV, setting a benchmark for managing this rare condition in pediatric urology.

Over the past two decades, there have been significant developments in paediatric urodynamic studies focusing on less-invasive monitoring devices, as well as re-defining normative values. This article reviews current paediatric urodynamic study methods and their reliability, and discusses new emerging ambulatory urodynamics and novel telemetric urodynamic devices. Traditional urodynamic studies are performed in specialised suites in real-time with artificial bladder filling. Ambulatory models allow for measurements in a more authentic environment and with natural bladder filling. Novel implanted telemetric monitoring devices provide a catheter-free solution but are inherently invasive in nature. Exploration of indirect measurements to obtain urodynamic data warrant further investigation. Definitive progress will require strong and sustained collaboration between end users and developers.

This article reviews the establishment and progress of the Multidisciplinary Paediatric Robotic Program in a high-volume paediatric surgery department at Hôpital Necker-Enfants Malades, Paris, France. A major foundational principle of the program was to establish a safe and secure environment for patients and staff, both pre-operatively, intra-operatively and post-operatively. This founding principle when applied systematically has allowed increasing confidence across the program and service. The robotic platform allows for precision surgery when approaching tumours, with freedom of movement adapted to meticulous vascular and organ dissection. Surgical feasibility is based on tumour characteristics, pre-operative imaging, with a focus on vascular and organ involvement, considering goals of surgery and surgical experience. Case complexity has been gradually increased (where appropriate) through an iterative process. The future of surgery is robotic, and even more so image-guided surgery, and this synergy has been instrumental when approaching tumour surgery in children. The current principles that guide application of robot-assisted surgery in paediatric tumours are presented. With this blueprint, excellent oncological outcomes can be achieved while utilising a minimally invasive approach in children with selected endocrine, neuroblastic and renal tumours.

AIM:The role of prenatal urinoma in lower urinary tract obstruction (LUTO) such as posterior urethral valves (PUV) is debated. We aimed to describe the risk factors associated with fetal urinoma and the association between fetal urinoma and postnatal renal function before 2 years of age. METHODS:This retrospective multicenter case-control study from 2000 to 2018 included pregnant patients with suspected LUTO in their male fetus on prenatal ultrasound and postnatal confirmation of PUV. The exposure criterion was prenatal urinoma. The main composit outcome (MCO) was chronic kidney disease stage 3 or higher (CKD3+) before 2 years or death. Descriptive analyses of patient data and crude and multivariate logistic regression analyses were performed in an intent-to-treat fashion, thus including lost-to-follow-up patients. Ethical approval # 20.144. RESULTS:We included 299 patients, of whom 39 (13%) had prenatal urinoma. Thirty-eight patients had a termination of pregnancy (12.7%). Sixty-four (24.5%) patients'children were MCO positive. Twenty-one children were lost-to-follow-up, including one prenatal urinoma. Thirty-nine (60.9%) of the remaining children had CKD3+ before the age of two, of whom 6 had a prenatal urinoma (9.4%). Among the 197 children negative to the MCO, 24 had a prenatal urinoma (12.2%, p = 0.42). Four died neonatally. In livebirth patients, prenatal urinoma was associated with obstetrical complications (p = 0.02), prenatal bloodcord sample for fetal beta2-microglobulin (p = 0.01) and uro-amniotic shunt (p = 0.01). Patients with prenatal urinoma more often presented with oligohydramnios (p = 0.01) and dilated posterior urethra (p = 0.01) and were less likely to have urinary tract infections (p = 0.02), although their DMSA scan was more often altered (p = 0.001). Prenatal urinoma was not significantly associated with CKD3+ before 2 years (OR = 0.56, CI98% = 0.20-1.39, p = 0.23). CONCLUSION:Renal function in infants with PUV was not worsened by the presence of a prenatal urinoma. Thus, there should not be any more pejorative message conveyed to concerned couples apart from other already known prenatal poor prognosis risk factors.

Objective: The aim of this guidance is to discuss the advantages of utilising adjunct technologies in minimally invasive surgery and to mitigate risks associated with these technologies in paediatric cancer surgery. Methods: A literature search was conducted, focusing on robotics, single-site and image-guided surgical approaches in paediatric cancer. Results: The findings indicate significant improvements in surgical precision, reduced morbidity and enhanced recovery times. Technologies such as robotics, single-site and image-guided surgical approaches have shown promising results in improving the precision of tumour resection. Conclusion: Integrating advanced technologies into paediatric cancer surgery offers the potential for improved surgical outcomes and quality of life for patients. However, ongoing research and careful implementation are necessary to ensure safety and efficacy.

OBJECTIVE:Robot-assisted surgery is now established in pediatric urology; however, data on indications and morbidity in children weighing less than 10 kg remain limited. This study evaluates the feasibility and outcomes of robotic surgery in infants. STUDY DESIGN:A retrospective analysis of prospectively collected multicentric data was performed over nine years (2015-2024) including infants weighing less than 10 kg who underwent robot-assisted urological surgery. Demographic data, perioperative characteristics, and complications were collected from seven university hospitals. RESULTS:83 infants were included, with a median age at surgery of 12 months (IQR: 8-16) and a median weight of 9 kg (IQR: 8-10). The main procedures were pyeloplasty (n = 37, 44 %), nephrectomy (upper pole or total, n = 20, 24 %), and adrenalectomy (n = 14, 17 %). Twenty-one procedures (25 %) were performed using a retroperitoneal approach. There were three conversions to open surgery: two during Wilms tumor surgery and one during bilateral adrenalectomy. The median hospital stay was 2 days (IQR: 1-3). Regarding 30-day morbidity, 10 infants (12 %) experienced complications (Grade II Clavien-Dindo), including febrile UTI (5 cases), stent displacement following pyeloplasty (3 cases), and transient urinary retention after bilateral ureteral reimplantation (2 cases). Additional complications observed beyond 30 days included two urinary tract infections (Grade II), one recurrence of hydrocolpos requiring reoperation (Grade IIIb), and one recurrence of ureteropelvic junction obstruction requiring reoperation (Grade IIIb). Median follow-up was 25 months (IQR: 11-66). CONCLUSION:This study demonstrates that robot-assisted urological surgery is feasible and safe in infants as young as three months of age. The reduced workspace does not appear to limit this surgical approach, whether via transperitoneal or retroperitoneal approach.

[This corrects the article DOI: 10.1016/j.ekir.2025.01.014.].

AIM:To determine the risk of Grades IV and V kidney injury due to common children's sports. METHODS:A systematic review of studies reporting traumatic kidney injuries (TKIs) associated with basketball, cycling, equestrian, motorsports, netball, rugby, Australian football or soccer. Studies with patients exclusively 18 years or older, non-TKIs or non-sport-related mechanisms were excluded. RESULTS:Twenty-five studies with 24 424 patients were included. The estimated risk of kidney loss from sports injuries is 0.37 per million child-years. However, the incidence of Grades IV and V injuries could not be calculated in at-risk populations due to limited prospective data. The prevalence of TKIs from sport-specific trauma was low, ranging from 0.6% to 2.2%. Few studies graded the severity of kidney injury, but in the small number reported, Grades IV and V injuries occurred in 33% of soccer TKIs, 26% of bicycling, 23% of Australian football, 20% of basketball and 17% of equestrian injuries. The high number of ungraded kidney injuries (5514/5607) impacts the reliability of findings. CONCLUSION:Recommendations to exclude children with congenital single kidneys from specific sports lack a firm evidence-base. Given bio-psycho-social consequences, such recommendations must be carefully considered, particularly for equestrian and motorised vehicles, which carry a higher risk of trauma.