Keyword: Minimally Invasive Surgery

ABSTRACT: Introduction: Vesicoureteral reflux (VUR) is one of the most prevalent conditions in pediatric urology, occurring in approximately 1–2% of children; among those presenting with urinary tract infections, VUR is detected in 25–40% of cases. The incidence shows no declining trend and increases annually in line with global population growth.
Methods: This retrospective-prospective, single-center, comparative cohort study enrolled 110 children aged 8 months to 18 years with VUR grades II–IV treated at the Specialized Pediatric Surgical Clinic of Samarkand State Medical University (1989–2022). Patients were allocated to two non-concurrent treatment groups based on the era of admission: the control group (CG, n=32; 1989–2011) underwent open antireflux surgery, and the study group (SG, n=78; 2012–2022) underwent endoscopic correction of VUR (ECVUR). Patients with grades I and V VUR were excluded.
Results: In the SG, the proportion of good outcomes was 78.2%, exceeding that of the CG (65.6%). Unsatisfactory results were 2.9-fold lower (6.4% vs. 18.8%). Hospitalization was significantly reduced from 16.7±3.3 to 5.2±1.2 bed-days (p<0.001). The economic efficiency coefficient improved 3.2-fold. Overall ECVUR efficacy was 93.6% versus 81.2% for open surgery.
Conclusion: Minimally invasive endourological methods demonstrate superior efficacy and safety compared with open antireflux surgery for the treatment of VUR in children.

ABSTRACT: Minimally invasive surgery (MIS) has become a dominant surgical paradigm over the last two decades due to its benefits such as less tissue trauma and shorter convalescence for patients. This narrative review presents the progress in MIS from conventional laparoscopic to robotic surgical interventions, highlighting advancements in technology, clinical and educational applications. Early advances in fiber-optic imaging, video-laparoscopy, and creation of corresponding surgical instruments enabled the transition from a purely diagnostic to therapeutic MIS approach and facilitated surgical innovation among many specialties. However, conventional laparoscopy is constrained by several factors, including rigidity of surgical instruments, two-dimensional imaging, and surgical ergonomics.
Recent advances in robotic-assisted surgery have sought to address several of these limitations by providing surgeons with greater dexterity, tremor filtering, motion scaling, improved three-dimensional visualization and enhanced intra-abdominal working space. Early clinical results are promising with evidence suggesting reduced postoperative morbidity in selected complex procedures, although outcomes for robotic and conventional laparoscopic approaches remain comparable for many standard operations. Moreover, MIS is influencing surgical training through the use of surgical simulation models, structured credentialing and performance-based skill assessments.
Although much has been achieved with MIS, there are barriers to its widespread adoption, namely cost and access in less well-resourced surgical environments, as well as concerns relating to equity, accountability and informed patient consent. Moving forward, incorporating emerging technologies such as artificial intelligence, augmented reality and semi-autonomous systems will be pivotal to optimizing MIS. The future of MIS lies in the provision of personalized surgical care as part of an overall vision for precision surgery.