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Mattioli G, Lena F, Fiorenza V, Carlucci M. Robotic ureteral reimplantation and uretero-ureterostomy treating the ureterovesical junction pathologies in children: technical considerations and preliminary results. J Robot Surg 2022; 17:659-667. [PMID: 36287349 DOI: 10.1007/s11701-022-01478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022]
Abstract
Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) and robotic ureteroureterostomy (RUU) are two mini-invasive surgical techniques that have begun to be performed in pediatric urology in recent years. RALUR has been employed especially for VUR treatment, while RUU is considered principally in case of complex doubled ureteral systems. Our aim is to discuss the safety and feasibility of these approaches in children, focusing on technical considerations and supporting their use in different anomalies and pathologies of the ureterovesical junction. We retrospectively collected data about 58 patients who underwent 44 dismembered RALUR (D-RALUR), 28 non-dismembered RALUR (ND-RALUR) and 5 RUU between May 2020 and December 2021. Indications for surgery were primary or secondary vesicoureteral reflux, megaureter, secondary UVJ obstructions, complicated doubled ureteral systems. Mean age was 3.5 years (range 0.6-12.9) and mean weight 17.1 (range 7.2-80). No intraoperative complications occurred nor conversion to open approach were reported. Major postoperative complications were reported in 11.7% of cases with a higher incidence for ND-RALUR. Mean hospital stay was 2.14 days (range 1-8). Success rate at the short-term follow-up was 91.9% for D-RALUR, 96.3% for ND-RALUR and 100% for RUU. RALUR and RUU are two feasible and safe procedures to perform in children. RALUR represents the most required and adequate technique in the treatment of UVJ pathologies, however, in selected cases RUU could represent an effective alternative that has to be considered.
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Affiliation(s)
- G Mattioli
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - F Lena
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - V Fiorenza
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Marcello Carlucci
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
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Navarrete-Arellano M. Robotic-Assisted Minimally Invasive Surgery in Children. LATEST DEVELOPMENTS IN MEDICAL ROBOTICS SYSTEMS 2021. [DOI: 10.5772/intechopen.96684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.
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Abstract
Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.
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Affiliation(s)
- Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Sun G, Yan L, Ouyang W, Zhang Y, Ding B, Liu Z, Yu X, Hu Z, Li H, Wang S, Ye Z. Management for Ureteral Stenosis: A Comparison of Robot-Assisted Laparoscopic Ureteroureterostomy and Conventional Laparoscopic Ureteroureterostomy. J Laparoendosc Adv Surg Tech A 2019; 29:1111-1115. [PMID: 31314664 DOI: 10.1089/lap.2019.0357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: To describe and analyze our experience of robotic-assisted laparoscopic ureteroureterostomy (RALU) and conventional LU for the repair of ureteral stenosis and compare the differences of safety and efficacy between RALU and LU. Materials and Methods: Patients who underwent RALU or LU for ureteral stenosis were retrospectively analyzed. Baseline characteristics, details of stenosis, surgery and some laboratory tests, and follow-up data were collected and analyzed. Results: Among 126 patients presented with ureteral stenosis, 65 patients underwent RALU and 61 patients underwent LU. All operations were completed successfully without conversion to open surgery. Both groups were comparable in baseline characteristics and details of stenosis. The mean operative time, suturing time, and hospitalization time of patients in RALU group were significantly less than those in LU group. The mean operative time of the RALU group was 126.34 minutes, whereas the mean operative time of the LU group was 176.57 minutes (P < .001). The average suturing time of RALU and LU was 26.88 and 70.43 minutes, respectively (P < .001). The mean hospitalization time of RALU and LU was 4.01 and 5.02, respectively (P < .001). RALU presented a lower degree of leukocytes rise than LU (P < .001). The mean follow-up time was 29.52 months. Conclusions: RALU and LU both are safe and feasible for ureteral stenosis with a low incidence of complications. Compared with LU, RALU may be a better choice with shorter operative time, suturing time, postoperative hospitalization time, and slighter inflammation. Further clinical studies of high quality are needed to confirm the priority of RALU.
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Affiliation(s)
- Guoliang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Beichen Ding
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ellison JS, Lendvay TS. Robot-assisted ureteroureterostomy in pediatric patients: current perspectives. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:45-55. [PMID: 30697563 PMCID: PMC6193430 DOI: 10.2147/rsrr.s99536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.
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Affiliation(s)
- Jonathan S Ellison
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
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Lu L, Bi Y, Wang X, Ruan S. Laparoscopic Resection and End-to-End Ureteroureterostomy for Midureteral Obstruction in Children. J Laparoendosc Adv Surg Tech A 2017; 27:197-202. [PMID: 27668835 DOI: 10.1089/lap.2016.0222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liangsheng Lu
- Division of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Yunli Bi
- Division of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiang Wang
- Division of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuangsui Ruan
- Division of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
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Herz D, Fuchs M, Todd A, McLeod D, Smith J. Robot-assisted laparoscopic extravesical ureteral reimplant: A critical look at surgical outcomes. J Pediatr Urol 2016; 12:402.e1-402.e9. [PMID: 27522319 DOI: 10.1016/j.jpurol.2016.05.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/08/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Published reports of outcomes of robot assisted laparoscopic ureteral reimplantation (RALUR) show mixed results that, on average, are inferior to open ureteral reimplant. We present a retrospective analysis of a prospective series of children who had RALUR from 2013 to June 2015. We hypothesized that surgical outcomes are based on identifiable risk variables. We provide a critical analysis of the relationship between patient characteristics and several surgical and non-surgical outcomes. METHODS We reviewed the records of children who had Robot-Assisted Laparoscopic (RAL) Ureteral Reimplant (UR) at Nationwide Children's Hospital. Patient age and gender, preoperative presentation, presence of preoperative bladder and bowel dysfunction (BBD), VUR grade and laterality, indication for operation, operative time, surgical outcome, surgical complications, post-operative prevalence of UTI, and pre- and post-operative status of BBD were recorded. We also recorded techniques for ureteral dissection, and closing the detrusorrhaphy. Surgical outcome was defined by post-operative VCUG. We define BBD based on publications by the standardization committee of International Children's Continence Society (ICCS). All statistical calculations were performed with STATA version 11. RESULTS We performed extravesical RALUR on 54 children for a total of 72 ureters. Overall the study children were 74% female. The mean and median age was 5.2 and 4.9 years, respectively. Mean overall hospital length of stay (LOS) was 1.64 days. The mean LOS was 1.26 for unilateral (RALUUR) and 2.39 days for bilateral (RALBUR) surgeries and was significant (p < 0.05). Overall surgical success was 85.2% of ureters and 84.7% of children. Stratified by unilateral and bilateral surgeries, unilateral success was 91.7%, and bilateral success was 77.8% of ureters, and 72.2% of children. In the 3 failures in the RALUUR group the mean postoperative VUR grade was 1.3 from a pre-op mean grade of 3.3, whereas in the RALBUR group, the mean VUR grade among the failures was 3.0 from a mean pre-op VUR grade of 3.7. Urinary leak from ureteral injury, and urinary obstruction were more common in the RALBUR group. Post-operative urinary retention occurred in 4 children in the RALBUR and none in the RALUUR groups. Four with VUR after RALBUR and one child after RALUUR had open ureteral reimplant. Post-op UTI and non-surgical readmissions were higher in the RALBUR group. CONCLUSIONS Bilateral RALUR is associated with higher failure rates, higher complication rates, higher re-operation rates, and more postoperative UTIs and nonsurgical readmissions compared with unilaterasl RALUR.
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Affiliation(s)
- Daniel Herz
- Nationwide Children's Hospital, Columbus, OH, USA.
| | - Molly Fuchs
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew Todd
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daryl McLeod
- Nationwide Children's Hospital, Columbus, OH, USA
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Biles MJ, Finkelstein JB, Silva MV, Lambert SM, Casale P. Innovation in Robotics and Pediatric Urology: Robotic Ureteroureterostomy for Duplex Systems with Ureteral Ectopia. J Endourol 2016; 30:1041-1048. [DOI: 10.1089/end.2015.0645] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J. Biles
- Some of the material in this article was presented at the 26th Congress of the European Society for Paediatric Urology (October 14–17, 2015)
- Division of Pediatric Urology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Julia B. Finkelstein
- Some of the material in this article was presented at the 26th Congress of the European Society for Paediatric Urology (October 14–17, 2015)
- Division of Pediatric Urology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Mark V. Silva
- Some of the material in this article was presented at the 26th Congress of the European Society for Paediatric Urology (October 14–17, 2015)
- Division of Pediatric Urology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Sarah M. Lambert
- Some of the material in this article was presented at the 26th Congress of the European Society for Paediatric Urology (October 14–17, 2015)
- Division of Pediatric Urology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Pasquale Casale
- Some of the material in this article was presented at the 26th Congress of the European Society for Paediatric Urology (October 14–17, 2015)
- Division of Pediatric Urology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
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Howe A, Kozel Z, Palmer L. Robotic surgery in pediatric urology. Asian J Urol 2016; 4:55-67. [PMID: 29264208 PMCID: PMC5730905 DOI: 10.1016/j.ajur.2016.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/21/2022] Open
Abstract
While robotic surgery has shown clear utility and advantages in the adult population, its role in pediatrics remains controversial. Pediatric-sized robotic instruments and equipment are not readily available yet, so certain modifications can be made in order to make robotic surgery successful in children. While the cost of robotic surgery remains high compared to open procedures, patients experience greater satisfaction and quality of life with robotic surgery. Robotic pyeloplasty is a standard of care in older children, and has even been performed in infants and re-do surgery. Other robotic procedures performed in children include heminephroureterectomy, ureteroureterostomy, ureteral reimplantation, urachal cyst excision, bladder diverticulectomy, and bladder reconstructive procedures such as augmentation, appendicovesicostomy, antegrade continence enema, bladder neck reconstruction and sling, as well as other procedures. Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection. Future improvements in technology with production of pediatric-sized robotic instruments, along with increases in robotic-trained pediatric urologists and surgeon experience along each's learning curve, will help to further advance the field of robotic surgery in pediatric urology.
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Affiliation(s)
- Adam Howe
- Steven and Alexandra Cohen Children's Medical Center Ringgold Standard Institution - Pediatric Urology, Center for Advanced Medicine Smith Institute for Urology, New Hyde Park, NY, USA
| | - Zachary Kozel
- Long Island Jewish Medical Center Ringgold Standard Institution - Urology, Center for Advanced Medicine Smith Institute for Urology, New Hyde Park, NY, USA
| | - Lane Palmer
- Steven and Alexandra Cohen Children's Medical Center Ringgold Standard Institution - Pediatric Urology, Pediatric Urology Associates, New Hyde Park, NY, USA
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Herz D, Smith J, McLeod D, Schober M, Preece J, Merguerian P. Robot-assisted laparoscopic management of duplex renal anomaly: Comparison of surgical outcomes to traditional pure laparoscopic and open surgery. J Pediatr Urol 2016; 12:44.e1-7. [PMID: 26443241 DOI: 10.1016/j.jpurol.2015.04.046] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/14/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Surgical management of duplex renal anomaly (DRA) is complex because of individual anatomic variation, competing priorities of vesicoureteral reflux (VUR) and ureteral obstruction present in the same child, the varied differential function of the different renal moieties, and the presence of voiding dysfunction and recurrent urinary tract infection (UTI). Robot-assisted laparoscopic (RAL) surgical management has been under-reported in this group of children but is becoming a viable alternative to traditional open surgery. OBJECTIVE The aim was to report the surgical outcomes of a series of children with DRA who had RAL surgery and compare these outcomes to historical cohorts of open and laparoscopic surgery. STUDY DESIGN This was a retrospective analysis of a prospective series of children who had RAL surgery for DRA over an 8-year period. Forty-five RAL surgeries were performed in 47 children. RAL heminephrectomy (RAL HN) was performed in 19 children for poorly or non-functional renal moiety. One had staged bilateral RAL HN. RAL ureteroureterostomy (RAL UU) was performed in 14 children for upper pole ureteral obstruction. Thirteen RAL common sheath ureteral reimplants (RAL csUN) with or without ureteral tapering were performed in 12 children with VUR and UTI. Diagnosis and demographics, results of preoperative imaging, intraoperative time stamps, perioperative complications, success rate, and renal outcomes were recorded. RESULTS Low-grade VUR present preoperatively in the RAL UU group all resolved within the follow-up period. Four (25%) children in the RAL HN group developed de novo VUR after surgery, which resolved in two (50%) and required surgery in two (50%). Grade I VUR after RAL csUR that occurred in two (14.3%) children was asymptomatic and observed when off preventative antibiotics. DISCUSSION Most children with DRA who need surgical treatment can be offered RAL surgery. We report good outcomes and improved operative times for RAL HN and UU that approach historical open and pure laparoscopic cohorts. However, RAL csUR, especially with ureteral tapering, is more complex and inherently susceptible to complications, and has not met the outcomes of the open gold standard. The limits of this study are that selection bias is present, and there is no study control cohort. CONCLUSIONS This report achieves its aim to report surgical outcomes of children who had RAL surgery for DRA.
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Affiliation(s)
- Daniel Herz
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Jennifer Smith
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daryl McLeod
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan Schober
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Janae Preece
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Merguerian
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA
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Kapoor V, Elder JS. Simultaneous bilateral robotic-assisted laparoscopic procedures in children. J Robot Surg 2015; 9:285-90. [PMID: 26530838 DOI: 10.1007/s11701-015-0528-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/17/2015] [Indexed: 01/06/2023]
Abstract
Our main objective is to report the feasibility of performing simultaneous robotic-assisted laparoscopic (RAL) heminephrectomy with contralateral ureteroureterostomy in children with bilateral duplicated systems. Three female children with bilateral congenital renal/ureteral anomalies underwent concurrent RAL simultaneous unilateral partial nephrectomy with ureterectomy and contralateral ureteroureterostomy with redundant ureterectomy using a four/five-port approach. Mean age at repair was 32.9 months (range 7-46 months) and mean weight was 13.7 kg (range 10.4-13.6 kg). The RAL heminephroureterectomy and contralateral ureteroureterostomy were performed via a four-port approach (five ports in one patient), and the patients were repositioned and draped when moving to the other side. Mean operative time was 446 min (range 356-503 min). Mean estimated blood loss was 23.3 cc (range 10-50 cc). Postoperative length of stay for two patients was 2 days and 1 day for one patient (mean = 1.7 days). Mean length of follow-up was 18.3 months (range 7-36 months). No significant intraoperative or postoperative complications occurred for any of the three patients. Two children had no hydronephrosis on postoperative imaging in follow-up, and one child had a small stable, residual pararenal fluid collection on the side of heminephrectomy. Two patients underwent postoperative ureteral stent removal under general anesthesia. In children with bilateral duplicated urinary tract with ureterocele, ectopic ureter, and/or vesicoureteral reflux, laparoscopic repair with robotic assistance can be accomplished safely in a single operative procedure with a short hospital stay.
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Affiliation(s)
- Victor Kapoor
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Jack S Elder
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA. .,Division of Pediatric Urology, MassGeneral Hospital for Children, 55 Fruit Street, WRN 11, Boston, MA, 02114, USA.
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Lee NG, Corbett ST, Cobb K, Bailey GC, Burns AS, Peters CA. Bi-Institutional Comparison of Robot-Assisted Laparoscopic Versus Open Ureteroureterostomy in the Pediatric Population. J Endourol 2015; 29:1237-41. [PMID: 26159231 DOI: 10.1089/end.2015.0223] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Ureteroureterostomy (UU) is a useful surgical option for the management of duplication anomalies as well as obstructed single system ureters for children. We aimed to evaluate the safety, efficacy, and outcomes of robot-assisted laparoscopic UU (RALUU) compared with open UU (OUU) in the pediatric population. PATIENTS AND METHODS A retrospective review was performed at two institutions including six surgeons' experience with all cases of RALUU and OUU from January 2005 to June 2014. Indications for a surgical procedure included duplex systems with an upper pole ectopic ureter, obstructed ureterocele or lower pole vesicoureteral reflux, and obstruction in a single system. Transureteroureterostomy, laparoscopic UU, and major reconstruction cases where UU was the secondary procedure were excluded. RESULTS There were 25 RALUU and 19 OUU cases included. All cases involved duplex systems except two proximal to distal anastomoses in single system obstructed kidneys. RALUUs were more likely to be performed proximally (P = 0.01) and with the use of cystoscopy and stent placement (P = <0.0001). Operative times and estimated blood loss were similar between the two groups. Postoperative complications included four febrile urinary tract infections in each group, one recurrence of nonfebrile urinary tract infection in the open group, and one postoperative obstruction at the ureterovesical junction because of attempted stent placement necessitating nephrostomy tube placement in the open group. This OUU patient was the only one to demonstrate more severe hydronephrosis after surgery on initial follow-up imaging that was again unrelated to the open UU procedure. RALUU had shorter hospital stays by 0.5 days (P = 0.04). CONCLUSION Robot-assisted laparoscopic UU is a safe and effective alternative to open UU in children with duplication anomalies and single system obstructed ureters. Operative times and complication rates were comparable with slightly shorter length of hospitalization in robotic cases.
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Affiliation(s)
- Nora G Lee
- 1 Department of Urology, Children's National Medical Center , Washington, District of Columbia
| | - Sean T Corbett
- 2 Department of Urology, University of Virginia Medical Center , Charlottesville, Virginia
| | - Kaitlan Cobb
- 3 Department of Urology, George Washington University Hospital , Washington, District of Columbia
| | | | - Amy S Burns
- 5 Department of Urology, Penn State Hershey Medical Center , Hershey, Pennsylvania
| | - Craig A Peters
- 1 Department of Urology, Children's National Medical Center , Washington, District of Columbia
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Ganpule AP, Sripathi V. How small is small enough? Role of robotics in paediatric urology. J Minim Access Surg 2015; 11:45-9. [PMID: 25598599 PMCID: PMC4290118 DOI: 10.4103/0972-9941.147689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 12/01/2022] Open
Abstract
The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series.
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Affiliation(s)
- Arvind P Ganpule
- Department of Urology, Muljbhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Venkat Sripathi
- Department of Pediatric Surgery/Urology, Apollo Children's Hospital, Thousand Lights, Chennai, Tamil Nadu, India
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Romao RLP, Figueroa V, Salle JLP, Koyle MA, Bägli DJ, Lorenzo AJ. Laparoscopic ureteral ligation (clipping): a novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties. J Pediatr Urol 2014; 10:1089-94. [PMID: 24881807 DOI: 10.1016/j.jpurol.2014.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 04/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A simplified approach for the surgical management of symptomatic ectopic ureters, associated with a non-functioning upper moiety, with laparoscopic ureteric clipping is presented in this research paper. MATERIALS AND METHODS Prospectively collected data on nine consecutive girls with ectopic ureters associated with urinary incontinence who underwent laparoscopic clipping between February 2011 and December 2013. Surgical technique consisted of cystoscopy and insertion of ureteral catheter in the lower pole ureter to aid in identification and clipping of the ectopic ureter, which was achieved by standard trans-peritoneal laparoscopy. RESULTS Median age was eight years (range 4-17 years). Diagnosis was based on clinical findings, which were supported by: ultrasound (US), nuclear scans and magnetic resonance urography in Cases 9, 8 and 5, respectively. Bilateral complete duplication was present in two patients; the combination of cystoscopy and laparoscopy allowed adequate identification of the ectopic ureter causing incontinence in both. All nine patients were immediately dry after surgery and remain asymptomatic after a maximum follow up of 27 months. Eight out of nine patients had developed some degree of asymptomatic upper pole hydronephrosis on follow-up US. CONCLUSION Laparoscopic clipping holds promise as a simple alternative to other more-complex surgical procedures in the treatment of incontinence due to an ectopic ureter. Despite favorable and encouraging initial results, further follow up is warranted in order to determine the fate of expected associated upper-pole hydronephrosis.
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Affiliation(s)
- R L P Romao
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - V Figueroa
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - J L Pippi Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - D J Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - A J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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Current perspectives in robotic assisted pediatric surgery. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Grimsby GM, Merchant Z, Jacobs MA, Gargollo PC. Laparoscopic-assisted ureteroureterostomy for duplication anomalies in children. J Endourol 2014; 28:1173-7. [PMID: 25010444 DOI: 10.1089/end.2014.0113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To describe a novel laparoscopic-assisted technique for ureteroureterostomy for the surgical management of a completely duplicated collecting system with an obstructed and/or ectopic ureter. PATIENTS AND METHODS A camera is placed through a 5-mm infraumbilical port and the duplicated ureters identified and delivered through a small inguinal incision with a laparoscopic Babcock clamp. The ureteroureterostomy is performed in an open fashion. The mean operative time, length of stay, success, and complications of nine patients who underwent this technique were reviewed and compared with a cohort of patients who underwent open ureteroureterostomy at a single institution. In addition, the existing literature on laparoscopic and robot-assisted ureteroureterostomy is reviewed. RESULTS There were no statistically significant differences in operative time (134 vs 133 min, P=0.950), length of stay (0.32 vs 0.33 days, P=0.929), complications (2 and 2, P=0.574), or rates of success (95% vs 100%, P=1.00) between the open and laparoscopic-assisted ureteroureterostomy groups. In addition, the operative times and length of stay in our laparoscopic cohort were shorter than a majority of the laparoscopic and robotic cases reported in the literature. CONCLUSIONS Laparoscopic-assisted ureteroureterostomy is a successful technique for the management of an ectopic and/or obstructed ureter in a completely duplicated collecting system. This technique combines the speed and ease of the open technique with the improved cosmesis and visualization of a laparoscopic approach and is thus a useful approach for the pediatric urologist.
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Affiliation(s)
- Gwen M Grimsby
- 1 Division of Pediatric Urology, Department of Urology, UT Southwestern Medical Center , Dallas, Texas
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de Lambert G, Fourcade L, Centi J, Fredon F, Braik K, Szwarc C, Longis B, Lardy H. How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures. Surg Endosc 2013; 27:2137-44. [PMID: 23355145 DOI: 10.1007/s00464-012-2729-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/01/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both our teams were the first to implement pediatric robotic surgery in France. The aim of this study was to define the key points we brought to light so other pediatric teams that want to set up a robotic surgery program will benefit. METHODS We reviewed the medical records of all children who underwent robotic surgery between Nov 2007 and June 2011 in both departments, including patient data, installation and changes, operative time, hospital stay, intraoperative complications, and postoperative outcome. The department's internal organization, the organization within the hospital complex, and cost were evaluated. RESULTS A total of 96 procedures were evaluated. There were 38 girls and 56 boys with average age at surgery of 7.6 years (range, 0.7-18 years) and average weight of 26 kg (range, 6-77 kg). Thirty-six patients had general surgery, 57 patients urologic surgery, and 1 thoracic surgery. Overall average operative time was 189 min (range, 70-550 min), and average hospital stay was 6.4 days (range, 2-24 days). The procedures of 3 patients were converted. Median follow-up was 18 months (range, 0.5-43 months). Robotic surgical procedure had an extra cost of <euro>1934 compared to conventional open surgery. CONCLUSIONS Our experience was similar to the findings described in the literature for feasibility, security, and patient outcomes; we had an overall operative success rate of 97 %. Three main actors are concerned in the implementation of a robotic pediatric surgery program: surgeons and anesthetists, nurses, and the administration. The surgeon is at the starting point with motivation for minimally invasive surgery without laparoscopic constraints. We found that it was possible to implement a long-lasting robotic surgery program with comparable quality of care.
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Affiliation(s)
- Guénolée de Lambert
- Department of General Pediatric Surgery and Pediatric Urology, CHU Tours, F-37000, Tours, France.
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Leavitt DA, Rambachan A, Haberman K, DeMarco R, Shukla AR. Robot-Assisted Laparoscopic Ipsilateral Ureteroureterostomy for Ectopic Ureters in Children: Description of Technique. J Endourol 2012; 26:1279-83. [DOI: 10.1089/end.2012.0041] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David A. Leavitt
- Division of Pediatric Urology University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
| | - Aksharananda Rambachan
- Division of Pediatric Urology University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
| | - Ken Haberman
- Division of Pediatric Urology University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
| | - Romano DeMarco
- Departments of Surgery and Pediatrics, University of South Dakota, Sioux Falls, South Dakota
| | - Aseem R. Shukla
- Division of Pediatric Urology University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
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Krauss A, Neumuth T, Wachowiak R, Donaubauer B, Korb W, Burgert O, Muensterer OJ. Laparoscopic versus robot-assisted Nissen fundoplication in an infant pig model. Pediatr Surg Int 2012; 28:357-62. [PMID: 22200733 DOI: 10.1007/s00383-011-3045-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical robots are designed to facilitate dissection and suturing, although objective data on their superiority are lacking. This study compares conventional laparoscopic Nissen fundoplication (CLNF) to robot-assisted Nissen fundoplication (RANF) using computer-based workflow analysis in an infant pig model. METHODS CLNF and RANF were performed in 12 pigs. Surgical workflow was segmented into phases. Time required to perform specific actions was compared by t test. The quality of knot-tying was evaluated by a skill scoring system. Cardia yield pressure (CYP) was determined to test the efficacy of the fundoplications, and the incidence of complications was compared. RESULTS There was no difference in average times to complete the various phases, despite faster robotic knot-tying (p = 0.001). Suturing quality was superior in CLNF (p = 0.02). CYP increased similarly in both groups. Workflow-interrupting hemorrhage and pneumothorax occurred more frequently during CLNF (p = 0.040 and 0.044, respectively), while more sutures broke during RANF (p = 0.001). CONCLUSION The robot provides no clear temporal advantage compared to conventional laparoscopy for fundoplication, although suturing was faster in RANF. Fewer complications were noted using the robot. RANF and CLNF were equally efficient anti-reflux procedures. For robotic surgery to manifest its full potential, more complex operations may have to be evaluated.
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Affiliation(s)
- Alexandra Krauss
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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20
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Abstract
UNLABELLED What's known on the subject? and What does the study add? Robot assisted laparoscopic surgery (RALS) is slowly gaining acceptance in the field of paediatric urology. Accumulating data on safety and efficacy when performing paediatric robotic urologic procedures has led paediatric urologists to gradually embrace increasingly more complex reconstructive surgeries. Indeed, the unique and delicate movements generated by the robotic system make this technology ideal for children who often require reconstructive procedures. We critically review the current role of RALS in paediatric urology and to analyse the published data, with a special emphasis on the most common applications. We also propose a structured plan to expedite training and the surgical 'learning curve'. OBJECTIVES To critically review the current role of robot-assisted laparoscopic surgery (RALS) in paediatric urology and to analyse the published data, with a special emphasis on the most common applications. One of the greatest benefits of RALS has been the ability to truly spread the application of minimally invasive surgery to paediatric surgical patients. The unique attributes of the robotic interface make this technology ideal for children with congenital anomalies, who often require reconstructive procedures. We also propose a structured plan to expedite training and the surgical 'learning curve'. PATIENTS AND METHODS Currently, almost all urological surgical procedures in children have been performed with the assistance of the robotic interface. The most commonly performed procedures include pyeloplasty, nephrectomy/hemi-nephrectomy and surgery for vesico-ureteric reflux. Initial series of bladder augmentation and appendicovesicostomy are available. RESULTS Initial results with RALS are encouraging and have shown safety similar to open procedures, and outcomes at least equivalent to standard laparoscopy. Accumulating data have consistently shown that postoperative analgesia requirements and overall hospital stay are decreased. However, operative durations are significantly longer than their open counterparts, but this is decreasing as experience accumulates. CONCLUSIONS RALS is already part of paediatric urological surgery. Larger single-institution case series and comparative studies with the open approach and multi-institutional meta-analyses will help to identify the benefits of RALS in paediatric urology.
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Affiliation(s)
- Marcelo A Orvieto
- Pediatric Urology, Section of Urology –Department of Surgery, University of Chicago, Comer Children's Hospital and Pritzker Medical School, Chicago, IL, USA
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Buffi N, Cestari A, Lughezzani G, Bellinzoni P, Sangalli M, Scapaticci E, Zanoni M, Annino F, Larcher A, Lazzeri M, Rigatti P, Guazzoni G. Robot-Assisted Uretero-Ureterostomy for Iatrogenic Lumbar and Iliac Ureteral Stricture: Technical Details and Preliminary Clinical Results. Eur Urol 2011; 60:1221-5. [DOI: 10.1016/j.eururo.2011.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/10/2011] [Indexed: 11/26/2022]
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Tomaszewski JJ, Casella DP, Turner RM, Casale P, Ost MC. Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol 2011; 26:602-13. [PMID: 22050504 DOI: 10.1089/end.2011.0252] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopy has become an effective modality for the treatment of many pediatric urologic conditions that need both extirpative and reconstructive techniques. Laparoscopic procedures for urologic diseases in children, such as pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation, have proven to be safe and effective with outcomes comparable to those of open techniques. Given the steep learning curve and technical difficulty of laparoscopic surgery, robot-assisted laparoscopic surgery (RAS) is increasingly being adopted in pediatric patients worldwide. Anything that can be performed laparoscopically in adults can be extended into pediatric practice with minor technical refinements. We review the role of laparoscopic and RAS in pediatric urology and provide technical considerations necessary to perform minimally invasive surgery successfully.
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Affiliation(s)
- Jeffrey J Tomaszewski
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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23
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Chen Z, Chen X, Wu ZH, Luo YC, Li NN. Treatment of Retrocaval Ureter by Retroperitoneal Laparoscopic Ureteroureterostomy: Experience on 12 Patients. J Laparoendosc Adv Surg Tech A 2011; 21:803-7. [PMID: 21854202 DOI: 10.1089/lap.2011.0211] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhong-Hua Wu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Cheng Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Nan-Nan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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24
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Complex robotic reconstructive surgical procedures in children with urologic abnormalities. Curr Opin Urol 2011; 21:314-21. [PMID: 21593671 DOI: 10.1097/mou.0b013e3283476f23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Robot-assisted laparoscopic surgery (RALS) is evolving rapidly in the pediatric surgical field. The unique attributes of the robotic interface makes this technology ideal for children with congenital anomalies who often require reconstructive procedures. Furthermore, the system can generate extremely delicate movements in a confined working space such as the one generally found in the pediatric population. Herein, we critically review the current experience with RALS placing a special emphasis in children undergoing complex reconstructive surgical procedures worldwide. RECENT FINDINGS A total of 42 original manuscripts on a variety of robot-assisted urologic surgical procedures in children were identified from a MEDLINE database search. Complex reconstructive procedures that are being currently performed include reoperative pyeloplasty, pyeloplasty in infants, pyelolithotomy, ureteropyelostomy/ureterostomy, bladder augmentation with or without appendico-vesicostomy, bladder neck sling procedure, among others. SUMMARY Initial results with robot assistance are encouraging and have demonstrated safety comparable to open procedures and outcomes at least equivalent to standard laparoscopy. Future development of smaller instruments, incorporating tactile feedback, will likely overcome current limitations and spread out the use of this technique in younger children and more advanced procedures.
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25
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Traxel EJ, Minevich EA, Noh PH. A Review: The Application of Minimally Invasive Surgery to Pediatric Urology: Lower Urinary Tract Reconstructive Procedures. Urology 2010; 76:115-20. [DOI: 10.1016/j.urology.2009.11.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 10/29/2009] [Accepted: 11/03/2009] [Indexed: 12/20/2022]
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26
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Yates DR, Mehta SS, Spencer PA, Parys BT. Combined antegrade and retrograde endoscopic retroperitoneal bypass of ureteric strictures: a modification of the ‘rendezvous’ procedure. BJU Int 2010; 105:992-7. [DOI: 10.1111/j.1464-410x.2009.08807.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee DI, Schwab CW, Harris A. Robot-assisted Ureteroureterostomy in the Adult: Initial Clinical Series. Urology 2010; 75:570-3. [DOI: 10.1016/j.urology.2009.09.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 08/25/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
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Smith KM, Shrivastava D, Ravish IR, Nerli RB, Shukla AR. Robot-assisted laparoscopic ureteroureterostomy for proximal ureteral obstructions in children. J Pediatr Urol 2009; 5:475-9. [PMID: 19356984 DOI: 10.1016/j.jpurol.2009.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 03/04/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Ureteropelvic junction obstruction is a common presentation in the pediatric population, but proximal ureteral obstructions are rare. In this setting, robot-assisted laparoscopy (RAL) offers a minimally invasive option to open or traditional laparoscopic repair. The present study demonstrates successful RAL in two children with proximal ureteral obstructions: one with a right retrocaval ureter and one with a left ureter entrapped between two lower-pole crossing vessels. METHOD After retrograde placement of a double-J ureteral stent, the child was secured in a lateral decubitus position exposing the affected side. A three-port RAL system was used to dissect free the obstructed ureter. A spatulated watertight ureteroureterostomy was then fashioned after transposition of the ureter into an anatomic position. Sutures and free instruments were passed into the peritoneal cavity via the 5-mm instrument ports, thus obviating the need for a separate assistant port. RESULTS RAL provided for crisp visualization, meticulous dissection, and precise approximation of the reconstructed ureter. In both patients, blood loss was negligible, narcotic use was minimal, and length of stay was roughly 30h. Follow-up imaging at 1 month showed excellent hydronephrosis resolution for both reconstructions. CONCLUSION These two cases demonstrate the feasibility of RAL for proximal ureteral anomalies in the pediatric population.
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Affiliation(s)
- K M Smith
- Department of Urologic Surgery, Pediatric Division, 420 Delaware Street S.E., MMC 394, University of Minnesota, Minneapolis, MN 55455, USA
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Abstract
OBJECTIVES This article reviews the evidence regarding the feasibility, safety, benefits, limitations, and costs of robotically assisted surgery in children, evaluates how the technology compares with other pediatric surgical techniques, and provides insights about the near and more-distant future of the technology. METHODS The peer-reviewed medical pediatric literature was searched for studies that provided evidence of the feasibility and safety of robotic surgery in children and for studies that compared pediatric robotic surgery with conventional laparoscopic surgery or open surgery. RESULTS A total of 8 case series and 5 studies comparing robotic surgery with open or conventional laparoscopic surgery met the selection criteria for review. A few small studies that focused on rare complex surgical procedures also were reviewed. All studies were designed to evaluate the feasibility and safety of robotic surgery in children. None of the studies was randomized, and some studies had a retrospective design. These studies demonstrated that a number of routine, robotically assisted, laparoscopic and thoracic procedures were feasible and safe when performed by surgeons experienced in the technique, although robotic surgery did not provide superior outcomes, compared with traditional laparoscopic and open surgery. The advantages of the robotic system were best seen in complex procedures that involved areas that were difficult to access and in procedures in which dissection of delicate, anatomic structures was required. CONCLUSIONS Robotic surgery is feasible and safe for a number of pediatric surgical procedures, but evidence that it offers better clinical outcomes than conventional open or laparoscopic techniques is lacking.
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Affiliation(s)
- Goedele van Haasteren
- Hayes Inc, Independent Health Technology Assessment Company, Lansdale, Pennsylvania 19446, USA.
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30
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Casale P, Lambert S. Robotic ureteroureterostomy in children with a duplex collecting system. J Robot Surg 2009; 3:161. [DOI: 10.1007/s11701-009-0153-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/17/2009] [Indexed: 11/30/2022]
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Casale P, Kojima Y. Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update. Scand J Surg 2009; 98:110-9. [DOI: 10.1177/145749690909800206] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laparoscopic procedures for urological diseases in children, such as nephrectomy, pyeloplasty and orchiopexy, have proven to be safe and effective with outcome comparable to the open procedure. However, main drawback has been the relatively steep learning curve for this procedure because of technical difficulties of suturing and anastomosis. More recently, robotic-assisted laparoscopic surgery (RAS) has gained enormous popularity in adult urology and is increasingly being adopted around the world; however, few pediatric urology series have been reported. RAS has several advantages over conventional laparoscopic surgery, with the main advantage being simplification and precision of exposure and suturing because of allowing movements of the robotic arm in real time with increased degree of freedom and magnified 3-dimentional view. These features render RAS ideal for complex reconstructive surgery in a pediatric urological population. This review discusses the role of RAS in pediatric urology, and provides some technical aspects of RAS and a critical summary of current knowledge on its indications and out-come. Almost all operations that are classically performed as open or conventional laparoscopic reconstructive surgery for children with urological anomalies could be replaced by RAS, which may be established as an alternative minimally invasive surgery in the future.
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Affiliation(s)
- P. Casale
- Division of Urology, the Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Y. Kojima
- Division of Urology, the Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Abaza R, Zafar SS. Techniques for laparoscopic and robotic localization of intraluminal ureteral pathology. Urology 2009; 73:582-5. [PMID: 19147208 DOI: 10.1016/j.urology.2008.08.486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/18/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Improvements in endoscopic technology have made open ureteral surgery uncommon. There remain cases of ureteral disease not amenable to ureteroscopic treatment, but laparoscopy allows even these complicated cases to be treated in a minimally invasive fashion. Laparoscopic and robotic surgical treatment of the ureter requires the ability to localize the diseased segment laparoscopically, even when the defect is within the lumen and cannot be seen externally or palpated as in open surgery. We describe 3 techniques to localize the disease within the ureter during laparoscopy and robotic surgery and the benefits and limitations of each technique. METHODS Three cases of laparoscopic and robotic ureteral surgery illustrate 3 different techniques used to localize disease within the ureteral lumen. The first case illustrates a ureteral occlusion balloon catheter used to identify a stricture by distending the collecting system proximal to the obstruction and cinching the balloon against the stricture. The second case illustrates a flexible ureteroscope introduced through a 5-mm port and into the incised ureter to guide excision of extensive polyposis. The third case, involving a polyp and stricture, illustrates a technique involving retrograde ureteroscopy with "cutting to the light" laparoscopically. RESULTS Three techniques are demonstrated to successfully localize intraluminal ureteral disease that could not be identified visually by laparoscopic inspection alone. These techniques also can minimize the extent of ureteral dissection to preserve blood supply. CONCLUSIONS Laparoscopy and robotic surgery can be successfully applied to benign ureteral disease not amenable to ureteroscopic treatment. Three cases are presented to illustrate 3 techniques for laparoscopic or robotic localization of intraluminal ureteral disease.
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Affiliation(s)
- Ronney Abaza
- Robotic Urologic Surgery, Ohio State University Medical Center, James Cancer Hospital, Columbus, Ohio, USA.
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Robot-assisted laparoscopic ipsilateral ureteroureterostomy for injury of an ectopic duplicated ureter following robotic prostatectomy. J Robot Surg 2008; 2:253-5. [PMID: 27637796 DOI: 10.1007/s11701-008-0113-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 09/14/2008] [Indexed: 10/21/2022]
Abstract
We report the feasibility and the safety of a robot-assisted laparoscopic ipsilateral ureteroureterostomy in a patient who had previously undergone a robot-assisted laparoscopic radical prostatectomy and was found postoperatively to have complete right sided ureteral duplication with apparent injury to the distal ectopic ureter. Robot-assisted laparoscopic ipsilateral ureteroureterostomy was performed transperitoneally using the same six port sites that had previously been used for the robotic prostatectomy. Rigid cystoscopy was performed at the time of the procedure to identify the normal ureter, perform a retrograde pyelogram, and place a double pigtail ureteral stent. The ureteroureterostomy anastamosis was performed using interrupted 4-0 polyglactin sutures. The operation was performed successfully and without complications. Total operating room time was 117 min. Robot time was 73 min. Estimated blood loss was 50 ml. Other than a brief episode of renal colic on postoperative day 2, the patient recovered uneventfully and was discharged home on postoperative day 4. Preoperative serum creatinine was 1.05 mg/dl and on the day of discharge was 0.85 mg/dl. Prostate pathology showed adenocarcinoma of the prostate, Gleason 3 + 4 = 7 with negative margins pathologic stage T2c.Robot-assisted laparoscopic ipsilateral ureteroureterostomy is safe and effective for the treatment of ureteral injury in a duplicated system.
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