Echocardiography

Advances in ultrasound technology will continue to expand the utility of

echocardiography in the assessment of structural and functional cardiac disease in children.
Tissue Doppler imaging and dobutamine stress echocardiography are 2 promising clinical
applications that are expected to become increasingly used with time. Advances in data
compression technology, including JPEG and MPEG techniques, will significantly affect digital
archival and transmission of echocardiograms, which also have clinical implications, particularly
in the expanding use of telemedicine.

Pediatric Urology
Flexible Robotic Ureterorenoscopy: Initial Experience: Monish Aron, Georges-Pascal
Haber, Mihir M Desai, Troy R Gainduzzo and Inderbir S. Gill reported their initial experimental
evaluation of a flexible robotic system (Hanseen Medical Mountain View Ca) for diagnostic and
therapeutic ureterorenoscopy in five female swine.

This system is composed of a remote catheter manipulator (RCM), a workstation console, an

electronics rack, a steerable scope (12F) and outer sheath (14F), which are in turn, controlled
with a joystick by a surgeon at the console. 85/86 calyces were successfully inspected in 10
kidneys. The time required to inspect the collecting system was 49secs-15min. Both
reproducibility (the ability to examine the calyx 3x) and stability (the ability to stay in position
for 5 min) were rated 10/10 on a visual analogue scale while the auto-retract mechanism was
rated at 8/10. All calculi inserted in these kidneys were successfully fragmented. Only one out of
ten kidneys (10%) had a perforation after the procedure.

The authors should be commended for such an excellent work on their initial experience with
robotic flexible ureteroscopy. This platform will undoubtedly serve as the take-off point for the
future development of a fully flexible robotic system which could be applied either
endoluminally or transabdominally through a single skin incision or through a natural orifice
(NOTES). Potentially, it could make the rigid robotic platform a thing of the past.

Augmented Reality Visualization during Laparoscopic Urologic Surgery: The Initial Clinical
Experience: Osamu Ukimura, Masahiko Nakamoto, Mihir M Desai, Brian Herts, Monish Aron,
Georges-Pascal Haber, Jihad H Kaouk, Tsuneharu Miki, Yoshinobu Sato, Makoto Hashizume,
Inderbir S Gill described their initial experience with the use of augmented reality for surgical
navigation in laparoscopic urology. They employed this method in 25 laparoscopic cases: partial
nephrectomy (9) radical nephrectomy (1) donor nephrectomy (1) radical prostatectomy (13) and
radical cystectomy (1). Accurate and precise imaging could be superimposed on the actual
intraoperative anatomy in the laparoscopic view, thus allowing real time surgical navigation and
dissection, facilitating complete extirpative tumor excision with negative margins in cancer
surgery as well as safe isolation of vascular structures in donor nephrectomy.

The authors should be commended for this large volume of experience in augmented reality.
This serves as a breakthrough for high precision surgery in this century. However, it should be
highlighted that the group of J Marescaux in France has originally demonstrated its use in
laparoscopic adrenalectomy in 2004.