Editorial Comment for Silay et al.

The authors should be congratulated on their work. Robotic or pure laparoscopic ureteral reimplantation is a procedure taken for granted as being a simple approach to correcting vesicoureteral reflux (VUR). This misconception flows from the fact that VUR is so widespread that the experience with minimally invasive surgery in this disease entity must be large just because of sheer numbers.

Robotic extravesical or intravesical reimplantation is quite challenging. Having performed both approaches, I believe the intravesical is much more difficult because of the many issues regarding bladder access and stability, as well as the working environment.

The outcomes across the U.S. might be considered unacceptable, and vary even among outstanding surgeons with great minimally invasive experience as reported by Grimsby and associates. ¹ There are reports, however, with helpful techniques showing outstanding results in the short and long term. ^2,3 What this proves to me is that we have become irresponsible with the dissemination of knowledge, which hinders our progress for one common goal we all have—the delivery of the best possible care for children.

How we rectify this dilemma is a challenge in the era where productivity with decreased reimbursement adds barriers to taking the time to ensure excellent outcomes and techniques become ubiquitous. Instead of reinventing the wheel in each region or each institution, it behooves us to join together, share our knowledge, be critical of our own and each other's techniques, swallow our pride, and strive to be better. We need to stop working in silos. How do we do it? I'm open to suggestions, but it seems we have no choice when outcomes vary so widely for such a common problem.