Scott E. Langenburg

Robotics in pediatric surgery: perspectives for imaging

Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. While robotic surgery is now in clinical use in several surgical specialties (heart bypass, prostate removal, and various gastrointestinal procedures), the greatest promise of robotics lies in pediatric surgery. We will briefly review the history and background of robotic technology in surgery, discuss its present benefits and uses and those being explored, and speculate on the future, with attention to the current and potential involvement of imaging modalities and the role of image guidance.

MRI detection of atrophic kidney in a hypertensive child with a single kidney

The role of magnetic resonance imaging (MRI) in the work-up of secondary causes of pediatric hypertension is typically restricted to that of renovascular causes where main renal artery stenosis is suspected. We report a case of a 10-year-old female child with hypertension, who was thought to have unilateral renal agenesis, because only a solitary left kidney could be visualized on both ultrasound and renal scintigraphy. Our patient underwent magnetic resonance imaging because of suspected renal artery stenosis in her solitary left kidney. At MRI she was found to have a normal left kidney. However, a very tiny, atrophic right kidney was also visualized. A laparoscopic right nephrectomy was performed, which resulted in complete resolution of her hypertension. This case illustrates a possible additional role for MRI in a very small subset of pediatric hypertensive patients: those with a single kidney on ultrasound.