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Abdulfattah S, Zirel L, Mittal S, Srinivasan A, Shukla AR. The missed crossing vessel during open pyeloplasty: a potential advantage of the robot-assisted approach in children. J Robot Surg 2024; 18:285. [PMID: 39012421 PMCID: PMC11252211 DOI: 10.1007/s11701-024-02006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/01/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To investigate whether the panoramic view offered by robot-assisted laparoscopic pyeloplasty (RALP) reduces the likelihood of missing a crossing vessel compared to open pyeloplasty in cases where initial pyeloplasty fails. METHODS A single institution redo-pyeloplasty database was reviewed for children treated between January 2012 to July 2023. Clinical history, imaging and operative details were reviewed to identify the etiology for the redo procedure. RESULTS Cohort consisted of 45 patients undergoing a redo RALP during the study period. 29 of 45 patients had an initial open surgical approach, whereas 16 had an initial RALP. 10 patients were noted to have a missed crossing vessel on redo pyeloplasty - 9 had an initial open approach whereas 1 had an initial RALP (p<0.0001). CONCLUSIONS RALP may reduce the risk of missing a crossing vessel due to the panoramic view of the surgical field intrinsic to an intraperitoneal RALP approach.
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Affiliation(s)
- Suhaib Abdulfattah
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA, 19104, USA
| | - Laura Zirel
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA, 19104, USA
- Division of Urology, North Estonia Medical Center, J. Sütiste Tee 19, Tallinn, Estonia
| | - Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA, 19104, USA
- Division of Urology, Perelman Center for Advanced Care, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA, 19104, USA
- Division of Urology, Perelman Center for Advanced Care, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Aseem R Shukla
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA, 19104, USA.
- Division of Urology, Perelman Center for Advanced Care, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
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Esposito C, Cerulo M, Lepore B, Coppola V, D'Auria D, Esposito G, Carulli R, Del Conte F, Escolino M. Robotic-assisted pyeloplasty in children: a systematic review of the literature. J Robot Surg 2023:10.1007/s11701-023-01559-1. [PMID: 36913057 PMCID: PMC10374693 DOI: 10.1007/s11701-023-01559-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023]
Abstract
Robotic pyeloplasty has become a natural progression from the development of open, then laparoscopic procedures to treat pediatric patients with ureteropelvic junction obstruction (UPJO). Robotic-assisted pyeloplasty (RALP) is now considered a new gold standard in pediatric MIS. A systematic review of the literature retrieved from PubMed and published in the last 10 years (2012-2022) was performed. This review underlines that in all children except the smallest infants, where the open procedure has benefits in terms of duration of general anesthetic and there are limitations in the size of instruments, robotic pyeloplasty is becoming the preferred procedure to perform in patients with UPJO. Results for the robotic approach are extremely promising, with shorter operative times than laparoscopy and equal success rates, length of stay and complications. In case of redo pyeloplasty, RALP is easier to perform than other open or MIS procedures. By 2009, robotic surgery became the most used modality to treat all UPJO and continues to grow in popularity. Robot-assisted laparoscopic pyeloplasty in children is safe and effective with excellent outcomes, even in redo pyeloplasty or challenging anatomical cases. Moreover, robotic approach shortens the learning curve for junior surgeons, who can readily achieve levels of expertise comparable to senior practitioners. However, there are still concerns regarding the cost associated with this procedure. Further high-quality prospective observational studies and clinical trials, as well as new technologies specific for the pediatric population, are advisable for RALP to reach the level of gold standard.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy.
| | - Mariapina Cerulo
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Benedetta Lepore
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Coppola
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Daniela D'Auria
- Faculty of Computer Science, Free University of Bolzano, Bolzano, Italy
| | - Giorgia Esposito
- Internal Medicine Unit, University of Naples "Federico II", Naples, Italy
| | - Roberto Carulli
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Fulvia Del Conte
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
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Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty. Int Urol Nephrol 2022; 54:2503-2509. [PMID: 35861906 PMCID: PMC9463286 DOI: 10.1007/s11255-022-03305-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/09/2022] [Indexed: 12/02/2022]
Abstract
Purpose This multi-institutional study aimed to assess the outcomes of laparoscopic ureterocalicostomy (LUC) and robot-assisted laparoscopic ureterocalicostomy (RALUC) and compare them with laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO). Methods The data of 130 patients (80 boys), with median age 7.6 years and median weight 33.8 kg, receiving minimally invasive treatment of PUJO over a 6-year period, were retrospectively analyzed. Patients were grouped according to the operative approach: G1 included 15 patients, receiving LUC (n = 9) and RALUC (n = 6), and G2 included 115 patients, receiving LP (n = 30) and RALP (n = 85). Patient characteristics and operative outcomes were compared in both groups. Results The median patient age and weight were significantly higher in G1 than in G2 [p = 0.001]. The median operative time was similar in both groups (157.6 vs 150.1 min) [p = 0.66] whereas the median anastomotic time was shorter in G1 than in G2 (59.5 vs 83.1 min) [p = 0.03]. The surgical success rate was similar in both groups (100% vs 97.4%) [p = 0.33]. Post-operative complications rate was higher in G1 than in G2 (20% vs 6.1%) but all G1 complications were Clavien 2 and did not require re-intervention. Conclusion LUC/RALUC can be considered safe and effective alternative approaches to LP/RALP for PUJO repair and reported excellent outcomes as primary and salvage procedures. Robot-assisted technique was the preferred option to treat most patients with recurrent PUJO in both groups. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03305-2.
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Du T, Qi P, He L, Yang S, Zhang B, Shang P. Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:871-883. [PMID: 35319279 DOI: 10.1089/lap.2021.0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.
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Affiliation(s)
- Tianci Du
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Qi
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Liangzhi He
- Department of Pediatric Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Biao Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
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Robotic-assisted laparoscopic pyeloplasty (RALP), for ureteropelvic junction obstruction (UPJO), is an alternative to open pyeloplasty in the pediatric population. J Robot Surg 2021; 16:1117-1122. [PMID: 34859365 DOI: 10.1007/s11701-021-01341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
We aimed to evaluate the safety and efficacy of RALP for UPJO in a heterogeneous pediatric population. The medical records of all patients with UPJO who underwent RALP over the last 6 years and completed at least 6 months of follow-up, were retrospectively reviewed. Data included age, sex, laterality, weight, preoperative and postoperative ultrasound and renal scintigraphy results, operation time, complications, length of hospital stay. We separately examined two groups: low-weight children (< 10 kg) and those who underwent RALP after failed pyeloplasty. One hundred patients with a median age of 18 months (range 2-216) underwent RALP. The median weight was 10 kg (range 4-90). The median operative time, including docking and console time, was 75 min (range 40-183). The median hospital stay was one day (range: 1-3). Ninety-eight percent of the patients showed improvement or stable hydronephrosis on postoperative imaging, with a better drainage curve on dynamic radionuclide scans. In two patients, the hydronephrosis worsened. One patient's ipsilateral UVJ was obstructed, and the other patient's UPJO recurred. The operative time was shorter in the low-weight group (p < 0.001), but the length of hospital stay and success rate were not different. Neither the hospital stay nor the success rate of redo RALP patients differed significantly from a control group of primary RALP patients. Our data show that RALP might be utilized as a universal approach in pediatric patients with UPJO.
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Rague JT, Shannon R, Rosoklija I, Lindgren BW, Gong EM. Robot-assisted laparoscopic urologic surgery in infants weighing ≤10 kg: A weight stratified analysis. J Pediatr Urol 2021; 17:857.e1-857.e7. [PMID: 34635439 DOI: 10.1016/j.jpurol.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Robot-assisted laparoscopic (RAL) urologic surgery is widely used in pediatric patients, though less commonly in infants. There are small series demonstrating safety and efficacy in infants, however, stratification by infant size has rarely been reported. Whether a cut-off weight, below which RAL surgery is not technically feasible, safe, or efficacious has not be determined. OBJECTIVE To assess safety and efficacy of RAL urologic procedures in infants <1 year of age, weighing ≤10 kg. STUDY DESIGN A single-institution retrospective cohort study of patients <1 year of age, and ≤10 kg undergoing RAL pyeloplasty (RALP) or RAL ipsilateral ureteroureterostomy (RALUU) between January 2011 and September 2020 was performed. Demographic, operative, and post-operative data were extracted from the medical record. Patients were stratified by post-hoc weight quartiles. Outcomes, including operative time, total OR time, estimated blood loss (EBL), post-operative length of stay (LOS), post-operative radiographic improvement, and 30-day complications were assessed by weight quartile for each procedure. The Kruskal-Wallis rank test was used to assess differences in continuous outcomes between weight quartiles and Pearson's Chi-squared test was used for categorical outcomes. RESULTS Of 696 RAL urologic surgeries performed, 101 met eligibility criteria. Median (IQR) age of patients was 7.2 (6.0-9.2) months with median weight of 8.0 (7.2-8.9) kg. The lowest weight was 5.5 kg. Procedures performed included 79 RALPs (78.2%), 22 RALUUs (21.8%). We identified 97 patients (94%) with post-operative imaging, with radiographic improvement in 92%. When stratified by weight quartile, there was no difference between groups in median operative time, total OR time, LOS, EBL, or post-operative radiographic improvement for both RALP and RALUU. Post-operative complications were assessed based on Clavien-Dindo classification with the majority of complications (9/12, 75%) in the >50th percentile weight groups. DISCUSSION To our knowledge, this is the largest published series of infant RAL urologic procedures, with similar rates of radiographic improvement and post-operative complications to prior published series. There are few prior series of RALP and RALUU in infants ≤10 kg, and we show comparable outcomes regardless of patient weight. Our study is limited by the inherent biases of retrospective studies. CONCLUSION RAL urologic surgery is technically feasible, safe, and efficacious in infants ≤10 kg, without worse outcomes as weight decrease. A cut-off weight, below which RAL surgery should not be performed has yet to be identified.
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Affiliation(s)
- James T Rague
- From the Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago (JR, RS, IR, BWL, EMG) and the Department of Urology, Northwestern University Feinberg School of Medicine (BLW, EMG), Chicago, IL, USA.
| | - Rachel Shannon
- From the Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago (JR, RS, IR, BWL, EMG) and the Department of Urology, Northwestern University Feinberg School of Medicine (BLW, EMG), Chicago, IL, USA.
| | - Ilina Rosoklija
- From the Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago (JR, RS, IR, BWL, EMG) and the Department of Urology, Northwestern University Feinberg School of Medicine (BLW, EMG), Chicago, IL, USA.
| | - Bruce W Lindgren
- From the Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago (JR, RS, IR, BWL, EMG) and the Department of Urology, Northwestern University Feinberg School of Medicine (BLW, EMG), Chicago, IL, USA.
| | - Edward M Gong
- From the Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago (JR, RS, IR, BWL, EMG) and the Department of Urology, Northwestern University Feinberg School of Medicine (BLW, EMG), Chicago, IL, USA.
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Mittal S, Aghababian A, Eftekharzadeh S, Dinardo L, Weaver J, Weiss DA, Long C, Srinivasan AK, Shukla AR. Primary vs redo robotic pyeloplasty: A comparison of outcomes. J Pediatr Urol 2021; 17:528.e1-528.e7. [PMID: 33766473 DOI: 10.1016/j.jpurol.2021.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Robot-assisted laparoscopic pyeloplasty (RALP) is a safe and efficacious option for repair of UPJO. We hypothesize that redo-RALP is technically more difficult but has comparable outcomes to primary RALP. METHODS An IRB-approved single institutional registry was utilized to identify all patients undergoing primary or redo RALP from 2012 to 2019. Redo RALP consisted of pyeloplasty and ureterocalicostomy (RALUC). Peri-operative and post-operative details and outcomes were aggregated. Successful reconstruction was defined as resolution of symptoms, improved hydronephrosis and no need for additional procedures. RESULTS From 399 patients who underwent UPJO repair at our center, a total of 306 with a median age of 4.9 years at surgery and a median follow-up of 18.5 months were included: 276 primary and 30 redo (21 RALP and 9 RALUC). Redo group had significantly longer procedure time and length of stay compared to the primary group. However, no significant difference was noted in the post-operative complications, need for additional endoscopic procedures or redo reconstruction, and success between the two groups. Multivariate analysis showed that when controlled for age, gender, 30-days post-operative complication and anatomy of obstruction, redo as compared to primary reconstruction did not have a significant effect on success. DISCUSSION This study is the largest controlled cohort in the pediatric population comparing redo RALP with an established control group -primary RALP. This retrospective chart review possesses the biases innate to any retrospective study. The low number of re-operative cases as well as low rate of failure in redo RALP further complicates identification of statistically significant predictors of outcomes following redo RALP. CONCLUSION Redo RALP is an efficient and safe approach for reconstruction of recurrent UPJO, with low complication rate and high success rate, comparable to primary RALP.
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Affiliation(s)
- Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Aznive Aghababian
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sahar Eftekharzadeh
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Lauren Dinardo
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - John Weaver
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Christopher Long
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Arun K Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA
| | - Aseem R Shukla
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA 19104, USA.
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Masieri L, Sforza S, Grosso AA, Valastro F, Tellini R, Cini C, Landi L, Taverna M, Elia A, Mantovani A, Minervini A, Carini M. Robot-assisted laparoscopic pyeloplasty in children: a systematic review. MINERVA UROL NEFROL 2020; 72:673-690. [DOI: 10.23736/s0393-2249.20.03854-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ceyhan E, Dogan HS, Tekgul S. Our experience on management of failed pediatric pyeloplasty. Pediatr Surg Int 2020; 36:971-976. [PMID: 32542506 DOI: 10.1007/s00383-020-04699-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention. METHODS 40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation. RESULTS Children's mean age at initial intervention for failed pyeloplasty was 45.9 (± 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (± 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05). CONCLUSIONS Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.
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Affiliation(s)
- Erman Ceyhan
- Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey. .,Department of Urology, Baskent University Konya Hospital, Konya, Turkey.
| | - Hasan Serkan Dogan
- Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
| | - Serdar Tekgul
- Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
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Zhang P, Shi T, Fam X, Gu L, Xuan Y, Yang L, Wang B, Ai X, Jia Z, Li H, Zhang X, Ma X. Robotic-assisted laparoscopic pyeloplasty as management for recurrent ureteropelvic junction obstruction: a comparison study with primary pyeloplasty. Transl Androl Urol 2020; 9:1278-1285. [PMID: 32676411 PMCID: PMC7354308 DOI: 10.21037/tau.2020.03.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To analyze the perioperative parameters and outcomes of robotic-assisted laparoscopic pyeloplasty (RALP) for recurrent ureteropelvic junction obstruction (UPJO) and compare them with our series of RALP for primary UPJO. Secondary pyeloplasty can be a challenging procedure because of ureteral devascularization, fibrosis and dense stricture formation. Robotic approach could be adjunct to these repairs. Methods Between August 2015 to March 2019, 96 patients in our hospital underwent RALP, with 32 patients as secondary intervention for recurrent UPJO. We compared the perioperative parameters of RALP for both primary UPJO and recurrent UPJO. Patient demographics, perioperative parameters, postoperative outcomes and complications from both groups were analyzed and compared. Results RALP was successfully performed for all cases in both groups. The median operating time was longer for secondary RALP than for primary RALP [125 (108.5–155) vs. 151 (120–190) minutes, P=0.004]. There were no conversions to open surgery or significant perioperative complications. No difference in blood loss, transfusion rate and perioperative complication rates was noted between the two groups. The success rates were 98.44% (63/64) and 96.88% (31/32) at a median follow up of 32 and 20 months (P=0.001) for the primary and secondary groups, respectively. Conclusions Secondary RALP is associated with significantly longer operative time as compared to primary RALP, especially during the exposure of the UPJO, however it is a safe surgical modality for recurrent UPJO with durable outcome. RALP should be an alternative treatment modality for recurrent UPJO whenever the facility and expert are available.
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Affiliation(s)
- Peng Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Taoping Shi
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xenginn Fam
- Urology Unit, Department of Surgery, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Yundong Xuan
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Luojia Yang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xing Ai
- Department of Urology, PLA Army General Hospital, Beijing 100853, China
| | - Zhuomin Jia
- Department of Urology, PLA Army General Hospital, Beijing 100853, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
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Esposito C, Masieri L, Blanc T, Musleh L, Ballouhey Q, Fourcade L, Escolino M. Robot-assisted laparoscopic pyeloplasty (RALP) in children with complex pelvi-ureteric junction obstruction (PUJO): results of a multicenter European report. World J Urol 2020; 39:1641-1647. [PMID: 32594228 DOI: 10.1007/s00345-020-03331-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to report a multi-institutional retrospective case series of outcomes after robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients with complex pelvi-ureteric junction obstruction (PUJO). METHODS All patients undergoing complex RALP over the last 5 years were included. RALP was defined complex in the following cases of PUJO: anatomic variations including ectopic, malrotated, horseshoe, or duplex kidney and recurrent PUJO after failed open pyeloplasty. RESULTS Forty-eight patients underwent complex RALP in four European centers in the study period and included 18 girls and 30 boys with a median age of 8 years (range 5-12). The PUJO was associated with anatomic variations in 35/48 (72.9%), whereas a recurrent PUJO was present in 13/48 (27.1%). A dismembered Anderson-Hynes pyeloplasty was performed in all patients. The median operative time including docking was 178.5 min (range 117-255) and the median anastomotic time was 64.8 min (range 50-76). All patients were discharged on 2nd postoperative day (POD). The median follow-up was 18.2 months (range 14-43). The overall success rate was 95.8% (46/48). Early postoperative complications (< 30th POD) included urinary tract infections (UTIs) and stent-related irritative symptoms in 4/48 (8.3%) [II Clavien], whereas late complications (> 30th POD) included recurrence of PUJO in 2/48 (4.2%), who needed re-operation [IIIb Clavien]. CONCLUSIONS RALP was safe, feasible, and with good mid-term outcome in complex PUJO. An accurate pre-operative planning, a standardized technique, and an experienced surgical robotic team represented key points to manage successfully such complex cases.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Urology, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Lorenzo Masieri
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - Thomas Blanc
- Division of Pediatric Urology, Hôpital Necker-Enfants Malades, Paris, France
| | - Layla Musleh
- Division of Pediatric Urology, Hôpital Necker-Enfants Malades, Paris, France
| | - Quentin Ballouhey
- Division of Pediatric Surgery, CHU de Limoges, Hopital de la Mère et de l'Enfant, Limoges, France
| | - Laurent Fourcade
- Division of Pediatric Surgery, CHU de Limoges, Hopital de la Mère et de l'Enfant, Limoges, France
| | - Maria Escolino
- Division of Pediatric Urology, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
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12
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Al-Hazmi H, Peycelon M, Carricaburu E, Manzoni G, Neel KF, Ali L, Grapin C, Paye-Jaouen A, El-Ghoneimi A. Redo Laparoscopic Pyeloplasty in Infants and Children: Feasible and Effective. Front Pediatr 2020; 8:546741. [PMID: 33240828 PMCID: PMC7683417 DOI: 10.3389/fped.2020.546741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine the feasibility and effectiveness of redo laparoscopic pyeloplasty among patients with failed previous pyeloplasty, specifically examining rates of success and complications. Materials and Methods: We retrospectively reviewed the charts of all patients, who underwent redo laparoscopic pyeloplasty from 2006 to 2017. This included patients who underwent primary pyeloplasty at our institution and those referred for failures. Analysis included demographics, operative time, complications, length of hospital stay, complications, and success. Success was defined as improvement of symptoms and hydronephrosis and/or improvement in drainage demonstrated by diuretic renogram, especially in those with persistent hydronephrosis. Descriptive statistics are presented. Results: We identified 22 patients who underwent redo laparoscopic pyeloplasty. All had Anderson-Hynes technique except two cases in which ureterocalicostomy was performed. Median (IQR) follow-up was 29 (2-120) months, median time between primary pyeloplasty and redo laparoscopic pyeloplasty was 12 (7-49) months. The median operative time was 200 (50-250) min, and median length of hospital stay was 3 (2-10) days. The procedure was feasible in all cases without conversion. During follow-up, all but two patients demonstrated an improvement in the symptoms and the degree of hydronephrosis. Ninety-one percent of patients experienced success and no major complications were noted. Conclusions: Redo laparoscopic pyeloplasty is feasible and effective with a high success rate and low complication rate.
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Affiliation(s)
- Hamdan Al-Hazmi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Matthieu Peycelon
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Department of Pediatric Urology Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Khalid Fouda Neel
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Liza Ali
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Christine Grapin
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
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13
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Wang Q, Lu Y, Hu H, Zhang J, Qin B, Zhu J, Dirie NI, Zhang Z, Wang S. Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach. PeerJ 2019; 7:e8166. [PMID: 31824773 PMCID: PMC6898986 DOI: 10.7717/peerj.8166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background Management of recurrent ureteral stricture is challenging. Consensus on the best surgical choice has not been demonstrated. In this study, we aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive. Methods We retrospectively assessed 41 patients (22 robot-assisted surgeries and 19 open surgeries) who underwent consecutive robot-assisted and open procedures for redo ureteral surgery from January 2014 to 2018 in our institution. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups. Results There was no significant intergroup difference in terms of age, body mass index, gender composition and American Society of Anesthesiologists scores. A total of 31 patients underwent redo pyeloplasty and ten underwent redo uretero-ureterostomy. Compared with open group, robot-assisted group showed shorter operative time (124.55 min vs. 185.11 min, p < 0.0001), less estimated blood loss (100.00 mL vs. 182.60 mL, p = 0.008) and higher cost (61161.77¥ vs. 39470.79¥, p < 0.0001). Complication rate and pain scores were similar between two groups. Median follow-up periods were 30 and 48 months for robot-assisted and open group respectively. Success rate in the robot-assisted (85.71%) and the open group (82.35%) was not significantly different. Conclusions Robot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss.
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Affiliation(s)
- Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Baolong Qin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianning Zhu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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14
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Mizuno K, Kojima Y, Nishio H, Hoshi S, Sato Y, Hayashi Y. Robotic surgery in pediatric urology: Current status. Asian J Endosc Surg 2018; 11:308-317. [PMID: 30264441 DOI: 10.1111/ases.12653] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022]
Abstract
Robot-assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3-D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.
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Affiliation(s)
- Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Seiji Hoshi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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15
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Tam YH, Pang KKY, Wong YS, Chan KW, Lee KH. From Laparoscopic Pyeloplasty to Robot-Assisted Laparoscopic Pyeloplasty in Primary and Reoperative Repairs for Ureteropelvic Junction Obstruction in Children. J Laparoendosc Adv Surg Tech A 2018; 28:1012-1018. [PMID: 29641368 DOI: 10.1089/lap.2017.0561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) are both minimally invasive surgical options to correct ureteropelvic junction obstruction in children. There are limited data reporting surgeons' experience of switching from LP to RALP and comparing the outcomes of the two procedures. METHODS We conducted a retrospective study on 63 consecutive children who underwent either LP or RALP by the same surgeon in a tertiary center from January 2008 to November 2016. LP had been the standard practice until January 2014 when it was replaced by RALP in short transition. RESULTS Thirty-seven LP and 26 RALP were successfully performed in children aged 2 months to 16 years. There was no difference between the two groups in age, body weight, laterality, clinical presentations, preoperative imagings, primary/reoperative repairs. The overall success rates were 34/37 (91.9%) and 25/26 (96.2%) for LP and RALP, respectively (P > .05). RALP was associated with shorter length of stay (3.1 days versus 4.0 days; P = .03). Surgeon-in-training participation was greater in RALP group (P < .001). There was no difference in operative time, complication rates, and analgesic requirement between the two groups. CONCLUSIONS Surgeons proficient in LP can adapt quickly to RALP, achieving comparable outcomes. Robotic technology may facilitate training on minimally invasive pyeloplasty.
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Affiliation(s)
- Yuk Him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Yuen Shan Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Kin Wai Chan
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Kim Hung Lee
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
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16
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Baek M, Silay MS, Au JK, Huang GO, Elizondo RA, Puttmann K, Janzen NK, Seth A, Roth DR, Koh CJ. Quantifying the Additional Difficulty of Pediatric Robot-Assisted Laparoscopic Re-Do Pyeloplasty: A Comparison of Primary and Re-Do Procedures. J Laparoendosc Adv Surg Tech A 2018; 28:610-616. [PMID: 29406807 DOI: 10.1089/lap.2016.0691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Re-do pyeloplasty after failed open or laparoscopic ureteropelvic junction (UPJ) obstruction correction can be a challenging procedure because of scar formation at the previous anastomosis site and decreased vascularity of the ureter. This study compared the perioperative parameters for pediatric robot-assisted laparoscopic (RAL) primary and re-do pyeloplasties with an emphasis on the intra-operative parameters. MATERIALS AND METHODS We compared the perioperative parameters of pediatric RAL procedures performed by a single surgeon at a tertiary care children's hospital for both primary ureteropelvic junction obstruction (UPJO) and recurrent UPJO after a previous open or laparoscopic procedure over 2013-2015. The operative time was subdivided as total operative time, console time, port placement time, dissection time to UPJ, and anastomosis time. RESULTS A total of 65 pediatric RAL pyeloplasty procedures for UPJO were performed (55 primary and 10 re-do pyeloplasties) during the study period. The console times were 43.3% longer for re-do pyeloplasties than for primary pyeloplasties (133.0 ± 30.7 versus 92.8 ± 24.0 minutes, respectively, P < .01). The re-do cases had longer operative times, especially for UPJ exposure (52.2 ± 21.0 versus 28.0 ± 14.0 minutes, P < .01). There were no conversions to open surgery or significant perioperative complications. There was no difference in hospital pain medication usage and hospital length of stay between the 2 groups. The treatment success rates were 98.2% (54/55) and 100% (10/10), respectively. CONCLUSIONS RAL re-do pyeloplasty is associated with significantly longer operative times as compared with primary pyeloplasties, especially during the exposure of the UPJ, but it is overall a safe and effective surgical modality for persistent/recurrent UPJO in children. As surgeons are increasingly asked for more accurate predictions of operative time lengths when scheduling cases, this information can be helpful for surgeons when scheduling these cases and with counseling families.
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Affiliation(s)
- Minki Baek
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas.,3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Mesrur Selcuk Silay
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas.,4 Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University , Istanbul, Turkey
| | - Jason K Au
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Gene O Huang
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Rodolfo A Elizondo
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Kathleen Puttmann
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Nicolette K Janzen
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Abhishek Seth
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - David R Roth
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Chester J Koh
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
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17
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Boysen WR, Gundeti MS. Robot-assisted laparoscopic pyeloplasty in the pediatric population: a review of technique, outcomes, complications, and special considerations in infants. Pediatr Surg Int 2017; 33:925-935. [PMID: 28365863 DOI: 10.1007/s00383-017-4082-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 12/16/2022]
Abstract
Ureteropelvic junction obstruction is a common condition encountered by the pediatric urologist, and treated with pyeloplasty when indicated. Recent technological advancements and a shift across all surgical fields to embrace minimally invasive surgery have led to increased utilization of minimally invasive pyeloplasty. Conventional laparoscopy is a reasonable choice, but its use is limited by the technical challenges of precise suturing in a confined space and the associated considerable learning curve. Robotic technology has simplified the minimally invasive approach to pyeloplasty, offering enhanced visualization and improved dexterity with a fairly short learning curve. As utilization of robotic pyeloplasty continues to increase, we sought to critically assess the literature on this approach. We begin with a review of the technical aspects of robot-assisted laparoscopic pyeloplasty including tips for surgical proficiency and patient safety. Outcomes and complications from the contemporary literature are reviewed, as well as special considerations in the pediatric population including infant pyeloplasty, cost concerns, training, and postoperative diversion/drainage.
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Affiliation(s)
- William R Boysen
- Pediatric Urology, Comer Children's Hospital, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, P-217, MC 7122, Chicago, IL, 60637, USA
| | - Mohan S Gundeti
- Pediatric Urology, Comer Children's Hospital, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, P-217, MC 7122, Chicago, IL, 60637, USA.
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18
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Hammady A, Elbadry MS, Rashed EN, Moussa A, Gamal W, Dawood W, Fahmy A, Abdelkareem A, Mahfouz W. Laparoscopic repyeloplasty after failed open repair of ureteropelvic junction obstruction: a case-matched multi-institutional study. Scand J Urol 2017; 51:402-406. [DOI: 10.1080/21681805.2017.1347819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Ahmed Moussa
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Wael Gamal
- Urology Department, Sohag University, Sohag, Egypt
| | - Waleed Dawood
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Ahmed Fahmy
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Ali Abdelkareem
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Wally Mahfouz
- Urology Department, Alexandria University, Alexandria, Egypt
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19
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Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP. Laparoscopic vs Open Pyeloplasty in Children: Results of a Randomized, Prospective, Controlled Trial. J Urol 2017; 197:792-797. [DOI: 10.1016/j.juro.2016.10.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/25/2022]
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20
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Ahn JJ, Shapiro ME, Ellison JS, Lendvay TS. Pediatric Robot-assisted Redo Pyeloplasty With Buccal Mucosa Graft: A Novel Technique. Urology 2017; 101:56-59. [DOI: 10.1016/j.urology.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/28/2016] [Accepted: 12/20/2016] [Indexed: 11/16/2022]
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21
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Davis TD, Burns AS, Corbett ST, Peters CA. Reoperative robotic pyeloplasty in children. J Pediatr Urol 2016; 12:394.e1-394.e7. [PMID: 27423387 DOI: 10.1016/j.jpurol.2016.04.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Reoperative pyeloplasty for recurrent ureteropelvic junction obstruction (UPJO) can be technically challenging and is associated with greater morbidity and lower success rates than an initial repair. Robotic-assisted laparoscopic pyeloplasty (RALP) previously has been demonstrated to be a safe and effective approach for management of recurrent UPJO; however, the length of follow-up has been limited. The objective of this study was to confirm the safety and efficacy of RALP for UPJO in children following failed previous pyeloplasty and provide clinical benchmarks for intermediate length follow-up in this patient population. METHODS An IRB approved retrospective chart review was performed for all patients undergoing reoperative RALP from June 2006 to December 2014. All cases were performed by surgeons from two institutions for persistent UPJO following failed initial pyeloplasty. Information including demographic information, radiographic studies, and operative interventions performed between the initial repair and reoperative surgery, reoperative RALP intraoperative data, postoperative clinical course and imaging studies, and subsequent interventions following reoperative RALP were extracted. RESULTS Twenty-three children underwent reoperative RALP. Eleven patients had right- and 12 left-sided repairs. Median age at reoperative RALP was 4.0 years and median interval between surgeries was 1.3 years. Indications for repeat repair included pain, infection, and/or radiographic evidence of worsening obstruction and/or deteriorating renal function. Mean operative time was 198 min from incision to port closure. Mean length of stay was 2.3 days. Six complications occurred in five patients within 30 days postoperatively, including ileus, pneumonia, and urinary tract infection. Median length of follow-up was 26 months (range 4-45 months) for all patients and 31 months (range 16-45 months) in 18 patients with >12 months of follow-up. More than 80% of patients presenting with flank pain prior to reoperative RALP had resolution of this symptom. To date, 78% of patients with >12 months of follow-up have not required further operative intervention. Excellent results have been achieved in 14 of 18 patients (78%) with sufficient postoperative follow-up in terms of length of follow-up (>12 months), symptom resolution, and/or improved imaging results. CONCLUSIONS RALP following previous pyeloplasty is technically feasible with acceptable operative times, lengths of stay, and complication rates. Reoperative RALP is our preferred modality for repair of recurrent UPJO with the vast majority of patients having successful outcomes based on imaging, resolution of symptoms, and the rare need for further intervention across an intermediate length follow-up period.
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Affiliation(s)
- T D Davis
- Children's National Health System, Washington, DC, USA.
| | - A S Burns
- Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - S T Corbett
- University of Virginia, Charlottesville, VA, USA
| | - C A Peters
- University of Texas Southwestern and Children's Medical Center, Dallas, TX, USA
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22
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Moscardi PRM, Barbosa JABA, Andrade HS, Mello MF, Cezarino BN, Oliveira LM, Srougi M, Dénes FT, Lopes RI. Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children: Safety and Efficacy of the Technique. J Urol 2016; 197:798-804. [PMID: 27789217 DOI: 10.1016/j.juro.2016.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Failure after pyeloplasty for ureteropelvic junction obstruction in children may occur in up to 10% of cases. Therapeutic options include Double-J® stent placement, endoscopic treatment and reoperation. Laparoscopic and robotic reoperative modalities seem safe and efficacious, although pediatric series are limited in the literature. We report the largest known series of reoperative laparoscopic ureteropelvic junction obstruction repair in children and compare this approach to primary laparoscopic pyeloplasty. MATERIALS AND METHODS We reviewed all children undergoing laparoscopic pyeloplasty at a single institution from 2004 to 2015. Reoperative laparoscopic ureteropelvic junction obstruction repair was compared to primary pyeloplasty. Groups were analyzed regarding demographics, operative time, complications, length of hospital stay and success, defined by improvement of symptoms, ultrasound and renogram. RESULTS We identified 11 cases of reoperation (8 redo pyeloplasties and 3 ureterocalycostomies) and 71 primary pyeloplasties. Groups were not different in age, gender or weight. Median followup was 37 months. Median time between primary pyeloplasty and reoperation was 34 months. Median operative time was 205 minutes for the reoperative group and 200 for primary pyeloplasty (p = 0.98). Length of stay was longer in the reoperative group (p = 0.049), although no major complications were recorded in this group. All reoperative cases and 96% of primary pyeloplasty cases remained asymptomatic following surgery (p = 0.99). Postoperative improvement was similar for both groups on ultrasound (90% for reoperation vs 92% for primary pyeloplasty, p = 0.99) and renogram (80% vs 88%, p = 0.6). CONCLUSIONS Laparoscopy seems to be safe and effective for management of failed pyeloplasty in children. Based on our data, reoperation is as safe and effective as primary pyeloplasty.
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Affiliation(s)
| | | | - Hiury Silva Andrade
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | - Miguel Srougi
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
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Abstract
The laparoscopic approach to the pyeloplasty procedure has proven to be safe and effective in the pediatric population. Multiple studies have revealed outcomes comparable to the open approach. However, a major drawback to laparoscopy is the technical challenge of precise suturing in the small working space in children. The advantages of robotic surgery when compared to conventional laparoscopy have been well established and include motion scaling, enhanced magnification, 3-dimensional stereoscopic vision, and improved instrument dexterity. As a result, surgeons with limited laparoscopic experience are able to more readily acquire robotic surgical skills. Limitations of the robotic platform include its high costs for acquisition and maintenance, as well as the need for additional robotic surgical training. In this article, we review the current status of the robot-assisted laparoscopic pyeloplasty, including a brief history, comparative outcomes, cost considerations, and training.
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Affiliation(s)
- Michael V Hollis
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Patricia S Cho
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Richard N Yu
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Bowen DK, Lindgren BW, Cheng EY, Gong EM. Can proctoring affect the learning curve of robotic-assisted laparoscopic pyeloplasty? Experience at a high-volume pediatric robotic surgery center. J Robot Surg 2016; 11:63-67. [PMID: 27342871 DOI: 10.1007/s11701-016-0613-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/12/2016] [Indexed: 12/01/2022]
Abstract
We sought to determine if the learning curve in pediatric robotic-assisted laparoscopic pyeloplasty (RALP) for an experienced open surgeon (OS) converting to robotics would be affected by proctoring from an experienced robotic surgeon (RS), and/or the experience of training within the framework of an established robotics program. We reviewed pediatric RALP cases by three surgeons at our institution, including the OS, RS, and a new fellowship-trained surgeon (FTS). We compared the first eight independent RALPs for the OS with the most recent ten RALPs for the RS. As an ancillary analysis, to isolate the impact of proctoring and of a robotics program, we reviewed the first ten cases of the FTS as well the first and last eight cases of the RS at a prior institution. A total of 44 patient charts were reviewed, with a mean follow-up time of 16 months (range 6.7-45 months). Radiologic improvement was seen in all patients with the exception of one who required reoperative pyeloplasty. The FTS, RS, and OS had similar mean operative times; however; when comparing robotic cases at the beginning of each of their learning curves, shorter operative times were achieved by the proctored surgeon (OS). Finally, comparing two RALP cohorts by the RS at his prior institution revealed longer operative times with an inexperienced robotics team. We demonstrate that an experienced open surgeon and fellowship-trained surgeon can quickly attain levels of expertise with pediatric RALP within an established robotic surgical program.
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Affiliation(s)
- Diana K Bowen
- Department of Urology, Feinberg School of Medicine, Northwestern University, Tarry 16-703, 303 E. Chicago Ave, Chicago, IL, 60611, USA.
| | - Bruce W Lindgren
- Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Tarry 16-703, 303 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Earl Y Cheng
- Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Tarry 16-703, 303 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Edward M Gong
- Division of Pediatric Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Tarry 16-703, 303 E. Chicago Ave, Chicago, IL, 60611, USA
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Salö M, Sjöberg Altemani T, Anderberg M. Pyeloplasty in children: perioperative results and long-term outcomes of robotic-assisted laparoscopic surgery compared to open surgery. Pediatr Surg Int 2016; 32:599-607. [PMID: 26833312 DOI: 10.1007/s00383-016-3869-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND A few studies have compared robotic-assisted laparoscopic pyeloplasty (RALP) with open pyeloplasty (OP) in children, but no previous study includes a long-term follow-up of renal function and hydronephrosis in combination with a thorough prospective follow-up of the RALP patients of at least 2 years. OBJECTIVE To analyze perioperative results and long-term outcome of children with obstruction of the ureteropelvic junction, operated on with RALP compared to OP. PATIENTS AND METHODS Children ≤15 years operated on with RALP or OP from 2000 through 2013 were reviewed. Patient demographics, perioperative data, postoperative complications, and long-term outcome were evaluated. The outcome was based on pre- and postoperative examination of renal function, hydronephrosis and flank pain. RESULTS 129 pyeloplasties (84 OP, 39 RALP, 6 reoperations) on 123 patients were included. RALP had significantly longer operative time and shorter postoperative hospital stay, compared to OP. No difference was found in postoperative need of morphine or complication rates. Mean follow-up for RALP with ultrasound was 29 and 25 months with renal scan, compared to 34 and 28 months, respectively, for OP. The success rate for flank pain was 96 and 94 %, for hydronephrosis 93 and 95 %, and renal function 94 and 92 %, for RALP and OP, respectively. CONCLUSIONS RALP is a safe method, with advantages compared to OP, and with the same success rate. This study supports the use of RALP in children.
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Affiliation(s)
- Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden. .,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Tania Sjöberg Altemani
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Magnus Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
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Dy GW, Hsi RS, Holt SK, Lendvay TS, Gore JL, Harper JD. National Trends in Secondary Procedures Following Pediatric Pyeloplasty. J Urol 2016; 195:1209-14. [PMID: 26926543 DOI: 10.1016/j.juro.2015.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database. MATERIALS AND METHODS Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics. RESULTS We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively). CONCLUSIONS Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.
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Affiliation(s)
- Geolani W Dy
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.
| | - Ryan S Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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Leung L, Chan IHY, Chung PHY, Lan LCL, Wong KKY, Tam PKH. Outcomes of Re-Intervention for Laparoscopic Transperitoneal Pyeloplasty in Children. J Laparoendosc Adv Surg Tech A 2016; 26:318-23. [PMID: 26799751 DOI: 10.1089/lap.2015.0095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is no consensus for the management of failed laparoscopic pyeloplasty in pediatric surgical patients, and only limited publications are available. We evaluated here the clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children. MATERIALS AND METHODS Retrospective review of all children who had undergone laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction from 2002 to 2013 was performed. Patients' demographics, indications, operative details, and outcomes for primary operation as well as re-intervention were studied. RESULTS There were 42 patients with a median age of 20 months (range, 3-192 months) and a median body weight of 12 kg (range, 6-56 kg) who underwent a total of 46 laparoscopic transperitoneal pyeloplasties during the study period. The median operative time and blood loss were 193 minutes (range, 115-480 minutes) and trace amount (range, trace amount to 400 mL), respectively. No conversion was reported. Ten cases (22%) required re-intervention. No statistically significant risk factor for failed pyeloplasty was identified. Indications for re-intervention included deterioration of differential renal function (n = 6), progressive hydronephrosis (n = 1), urinary ascites (n = 2), and urosepsis (n = 1). Median time of re-intervention was 6.5 ± 38 months postpyeloplasty. Re-intervention was categorized into the redo pyeloplasty group (n = 6) and the urinary diversion group (n = 4) (insertion of double-J ureteral stent or endopyelotomy) with success rates of 50% and 25%, respectively. Among the redo pyeloplasty group, 3 patients underwent redo laparoscopic pyeloplasty, and all of them had drainage restored with a median improvement in differential renal function of 11%. The mean follow-up duration was 77 ± 38 months. CONCLUSIONS Laparoscopic transperitoneal pyeloplasty is safe and feasible in children. Redo pyeloplasty is a more favorable re-intervention compared with urinary diversion in our series. Redo laparoscopic pyeloplasty has been shown to improve differential renal function.
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Affiliation(s)
- Ling Leung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Ivy Hau Yee Chan
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Patrick Ho Yu Chung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Lawrence Chuen Leung Lan
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Kenneth Kak Yuen Wong
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Paul Kwong Hang Tam
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
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Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction Following Open Pyeloplasty in Children. J Laparoendosc Adv Surg Tech A 2015; 25:858-63. [DOI: 10.1089/lap.2015.0074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Parente A, Angulo J, Burgos L, Romero R, Rivas S, Ortiz R. Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in Children. J Urol 2015; 194:184-9. [DOI: 10.1016/j.juro.2015.01.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/16/2022]
Affiliation(s)
- A. Parente
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - J.M. Angulo
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - L. Burgos
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - R.M. Romero
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - S. Rivas
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - R. Ortiz
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
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Ekin RG, Celik O, Ilbey YO. An up-to-date overview of minimally invasive treatment methods in ureteropelvic junction obstruction. Cent European J Urol 2015; 68:245-51. [PMID: 26251754 PMCID: PMC4526614 DOI: 10.5173/ceju.2015.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/15/2015] [Accepted: 04/18/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction have been developed and are bcoming more popular. Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, for both the transperitoneal and retroperitoneal approaches. In this review, we aimed to analyze the current status of minimally invasive therapy of ureteropelvic junction obstruction. Material and methods A PubMed database search was conducted to examine minimally invasive treatments of ureteropelvic junction obstruction. Results A large number of cases have been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric populations. A clear advantage, in terms of hospital stay, of minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Studies have shown that minimally invasive pyeloplasty techniques are a safe, effective, and feasible in adult and pediatric populations.
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Affiliation(s)
- Rahmi Gokhan Ekin
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Orcun Celik
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
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Lindgren BW. Appendicovesicostomy--What is the Best Technique for a Good Operation? J Urol 2015; 194:617-8. [PMID: 26079331 DOI: 10.1016/j.juro.2015.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Bruce W Lindgren
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abraham GP, Siddaiah AT, Ramaswami K, George D, Das K. Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty. Urol Ann 2015; 7:183-7. [PMID: 25834982 PMCID: PMC4374256 DOI: 10.4103/0974-7796.150489] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/24/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim was to analyze the operative, postoperative and functional outcome of laparoscopic management of previously failed pyeloplasty and to compare operative and postoperative outcome with laparoscopic pyeloplasty for primary ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS All patients who underwent laparoscopic management for previously failed dismembered pyeloplasty were analyzed in this study. Detailed clinical and imaging evaluation was performed. Transperitoneal approach was followed to repair the recurrent UPJO. Operative, postoperative, and follow-up functional details were recorded. Operative and postoperative outcomes of laparoscopic redo pyeloplasty were compared with that of laparoscopic primary pyeloplasty. RESULTS A total of 16 patients were managed with laparoscopic approach for previously failed pyeloplasty. Primary surgical approach for dismembered pyeloplasty was open in 11, laparoscopy in four patients and robotic assisted in one patient. Fifteen were treated with redo pyeloplasty and one with ureterocalicostomy. Mean operative time was 191.25 ± 24.99 min, mean duration of hospital stay was 3.2 ± 0.45 days and mean follow-up duration was 29.9 ± 18.5 months with success rate of 93.3%. Operative time was significantly prolonged with redo pyeloplasty group compared with primary pyeloplasty group (191.25 ± 24.99 vs. 145 ± 22.89, P = 0.0001). CONCLUSION Laparoscopic redo pyeloplasty is a viable option with a satisfactory outcome and less morbidity.
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Affiliation(s)
- George P Abraham
- Department of Urology, Lakeshore Hospital and Research Centre, Kochi, Kerala, India
| | - Avinash T Siddaiah
- Department of Urology, Lakeshore Hospital and Research Centre, Kochi, Kerala, India
| | | | - Datson George
- Department of Urology, Lakeshore Hospital and Research Centre, Kochi, Kerala, India
| | - Krishanu Das
- Department of Urology, Lakeshore Hospital and Research Centre, Kochi, Kerala, India
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Failed pyeloplasty in children: Is robot-assisted laparoscopic reoperative repair feasible? J Pediatr Urol 2015; 11:69.e1-6. [PMID: 25791423 DOI: 10.1016/j.jpurol.2014.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In this study we aim to demonstrate that robot-assisted laparoscopic (RAL) reoperative repair is safe and effective and even less technically demanding than open repair for recurrent ureteropelvic-junction obstruction (UPJO). STUDY DESIGN A retrospective study was conducted of all cases of failed open pyeloplasties who underwent RAL reoperative repair at our institution between January 2010 and December 2013. The general surgical procedure was the same we previously described for robot-assisted laparoscopic pyeloplasty. Success was defined as: improvement in the degree of hydronephrosis at ultrasound, improvement of diuretic washout time at postoperative diuretic renogram (<15 min), improvement or at least stable differential renal function and absence of symptoms. These radiographic and symptomatic criteria of success were considered the primary outcomes. Secondary outcomes included complications and length of hospital stay. RESULTS Between 2000 and 2013 a total of 153 patients underwent open Anderson-Hynes dismembered pyeloplasty. Of these 9 (6%) had recurrent UPJO. Four patients underwent open redo pyeloplasty. As a result, our study population comprised 5 children who underwent reoperative RALP repair. Patient characteristics and outcomes are summarized in the table below. Our success rate was 100%. DISCUSSION Due to the low failure rate of open dismembered pyeloplasty there is no consensus on the best surgical approach for recurrent obstruction. While endoscopic approaches have been favored in adults, children have shown better success rates with repeat pyeloplasty. Laparoscopic salvage pyeloplasty for failed open procedures has become more popular and has been shown to result in excellent outcomes while providing the advantages of minimally invasive surgery. To date, the literature regarding the use of RALP for failed open procedures in the pediatric population is scarce. Only 2 pediatric series of robotic reoperative pyeloplasty have been reported by Helmal et al. (9 patients) and Lindgren et al. (16 patients) with a success rate of 100 and 88%, respectively. Although this is one of the first published studies about robot-assisted laparoscopic reoperative repair for failed open pyeloplasty in pediatric patients, we acknowledge the limitations of our study due to the small number of patients, its retrospective nature and limited follow-up time. CONCLUSIONS The incidence of failed open pyeloplasty is as low as 5% and management remains controversial. As reported by other authors, we believe that crossing vessels play a particularly important role in secondary obstruction and adversely impact the outcome. Redo pyeloplasty, open or minimally invasive, is associated with high success rates (80-100%) and therefore considered the treatment of choice by the majority of authors nowadays. Additionally, RALP for secondary procedures has demonstrated to be safe and even less technically demanding when compared to the open approach, providing the advantages of minimally invasive surgery.
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Robot assisted laparoscopic pyeloplasty in obese and non-obese patients. J Pediatr Urol 2014; 10:1206-11. [PMID: 25037510 DOI: 10.1016/j.jpurol.2014.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We assessed whether increased BMI has a negative impact in children undergoing robot assisted laparoscopic pyeloplasty (RALP). PATIENTS AND METHODS Records of patients who underwent RALP were retrospectively reviewed and separated into healthy weight, overweight, and obese cohorts based on age-adjusted BMI percentile, and surgical and postsurgical outcomes were evaluated. RESULTS Of the 103 patients, there were 79 healthy weight and 24 overweight, with 10 of the 24 considered obese (BMI<85th, ≥85th, and ≥95th percentile for age, respectively). Cohorts were similar in respect to age, sex, laterality and symptoms. Operative time (234 min, 241 min, p=0.642; 254 min, p=0.324), EBL (7.1 ml, 10.5 ml, p=0.293; 6.8 ml, p=0.906), length of stay (1.2d, 1.2d p=0.545; 1.1d p=0.550), and narcotic administration (0.25 mg/kg, 0.25 mg/kg, p=0.545; 0.13 mg/kg, p=0.430) were similar between healthy weight, overweight, and obese cohorts, respectively. Complication rates were similar in regard to minor and major complications. There was no difference in decreased hydronephrosis (92.2%, 89.6%, p=0.440; 88.9%, p=0.730). Four patients (3.4%) required a reoperative procedure (three healthy weight, one overweight; p=NS). CONCLUSIONS Despite the potential difficulties with surgery in overweight patients, our data indicate that robot-assisted laparoscopic pyeloplasty can be performed as safely and effectively in overweight or obese children as in healthy weight children.
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Chung PH, De S, Gargollo PC. Robotic appendicovesicostomy revision in children: description of technique and initial results. J Endourol 2014; 29:271-5. [PMID: 25192597 DOI: 10.1089/end.2014.0550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report our initial results of robotic appendicovesicostomy (APV) revision in children. PATIENTS AND METHODS Three patients (median age 6 years; range 6-13) underwent robot-assisted APV surgery for bladder dysfunction because of posterior urethral valves, myelomeningocele, and traumatic spinal cord transection. Leakage developed in each patient from the APV. After failing more conservative treatments, the patients subsequently underwent robot-assisted APV revision. RESULTS Robot-assisted APV revision was conducted at a median 14 months (range 6-34 mos) after initial surgery. Median operative time was 165 minutes (range 106-232 min), and blood loss was ≤5 mL for all patients. Intraoperative findings ranged from partial to complete separation of the APV from the bladder tunnel. APV leakage resolved for all patients at last follow-up (median 5 months; range 2-9 mos). CONCLUSION This initial series expands the scope of robotic surgical procedures in children. Robot-assisted APV revision was technically feasible and safe in this early experience.
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Affiliation(s)
- Paul H Chung
- 1 Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center , Dallas, Texas
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Simforoosh N, Abedi A, Hosseini Sharifi SH, Poor Zamany N K M, Rezaeetalab GH, Obayd K, Soltani MH. Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age. J Pediatr Urol 2014; 10:819-23. [PMID: 24613142 DOI: 10.1016/j.jpurol.2014.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate safety, efficacy, and cosmetic results after mini laparoscopic (mL) pyeloplasty and standard (sL) pyeloplasty in children younger than 1 year of age with ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS From August 2009 to March 2011, 20 sL pyeloplasties were performed in pediatric patients younger than 1 year of age; afterwards, 20 patients younger than 1 year of age underwent mini laparoscopic (mL) pyeloplasty from June 2011 to August 2012. The patients were followed by urine culture and ultrasonography at 3 and 6 months after surgery. Cosmetic appearance was assessed in all patients in both groups group 3 months after surgery using the Patient Scar Assessment Questionnaire. RESULTS Peri and postoperative results revealed that operative time (total and anastomosis of ureteropelvic junction), hospital stay, and overall complication rate were significantly lower in mL than in sL. Persistent hydronephrosis in follow-up imaging and recurrence of obstruction was not observed in any cases. Mean appearance score and consciousness score showed significantly better results in the mL group. CONCLUSION We believe that mL pyeloplasty in infant cases with UPJO is more cosmetically pleasing and less invasive than sL pyeloplasty and has similar functional outcomes.
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Affiliation(s)
- N Simforoosh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - A Abedi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - S H Hosseini Sharifi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - M Poor Zamany N K
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - G H Rezaeetalab
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - K Obayd
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - M H Soltani
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran.
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Abstract
We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide.
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Affiliation(s)
- James T Kearns
- Department of Surgery, Section of Urology, University of Chicago Medicine, Comer Hospital, Chicago, IL, USA
| | - Mohan S Gundeti
- Department of Surgery, Section of Urology, University of Chicago Medicine, Comer Hospital, Chicago, IL, USA
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Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, Stein RJ, Gettman M. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 2013; 65:430-52. [PMID: 23856037 DOI: 10.1016/j.eururo.2013.06.053] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/26/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. OBJECTIVE To critically analyze the current status of laparoscopic and robotic repair of UPJO. EVIDENCE ACQUISITION A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. EVIDENCE SYNTHESIS Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. CONCLUSIONS Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
| | - Giorgio Guazzoni
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Nicolòmaria Buffi
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Craig A Peters
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Baskin LS. This Month in Pediatric Urology. J Urol 2012. [DOI: 10.1016/j.juro.2012.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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