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Rodriguez MV, Pena P, Vargas E, Yankovic F, Reed F, Ovalle JR, Lopez PJ, Braga LH, Prieto JC. Open distal ureteroureterostomy for non-refluxing duplicated collecting system in children: Multicentric study and mid-term outcomes. J Pediatr Urol 2024:S1477-5131(24)00431-5. [PMID: 39218731 DOI: 10.1016/j.jpurol.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND When indicated, ureteroceles and ectopic ureters in duplicated collecting systems can be managed via upper or lower urinary tract surgical approaches, or a combination of both. Open ureteroureterostomy (UU) has been described to address these conditions in the absence of lower pole (LP) vesicoureteral reflux (VUR). We report outcomes from multiple centers worldwide with mid-term follow-up. METHODS Our study consists of a retrospective review of records and imaging of children who underwent open distal UU via inguinal incision for duplicated collecting system without lower pole VUR in institutions from North America, South America, and the Caribbean. Descriptive statistics and univariate analysis were utilized. RESULTS The records of 127 patients who underwent open distal UU for double collecting system between 2009 and 2022 were reviewed. Of those, 65% were female (n = 82), with a mean age at operation of 18 months (range 3-180). Main presentation at surgery included prenatal hydronephrosis (64%, n = 81), followed by febrile urinary tract infections (28%, n = 36), and urinary incontinence or other (8%, n = 10). The patients with antenatal or incidental diagnosis of hydronephrosis were classified as preoperative Society for Fetal Urology (SFU) grade 3 (n = 64) and 4 (n = 54) (96%). Those who were classified with SFU grade 0-2 (4%) had symptomatic clinical presentations including febrile urinary tract infections (UTIs) (n = 3), urinary incontinence (n = 3), and a 12-year-old patient with recurrent abdominal pain (n = 1). Mean operative time from skin incision to skin closure was 86 min (range 45-240). Mean hospital stay was estimated at 1.1 days (range 0.5-4). In our cohort of 127 patients, 3 (2%) developed Clavien-Dindo grade I (2 with ureteral stent displacement and 1 with a urine leak/managed conservatively), 6 (5%) with grade II (3 febrile and 3 non-febrile UTIs managed with oral antibiotics), and 2 (2%) with grade IIIb complications (urine leaks requiring surgical management), which were appropriately treated. None presented grade IV or V complications. A double J stent was used in 56 patients (44%), and a Penrose drain was left in 10 (8%). A total of 125 children (98%, n = 125/127) showed sonographic improvement of hydronephrosis, or resolution of symptoms with stable ultrasound findings. Successful outcome was similar for both ureterocele and ectopic ureter subgroups: 49/49 patients with ureterocele showed 100% improvement, 76/78 children with ectopic ureter showed improvement in 97% of the cases. On univariate analysis, outcomes were similar regardless of the use of ureteral stents (p = 0.11). Mean follow-up was 28.2 months (range 12-85). CONCLUSIONS Open distal UU is a good alternative for the definitive surgical management of ectopic ureters and ureteroceles without LP VUR. This multicentric and mid-term follow-up study demonstrates that open distal UU offers high success rates, low morbidity, short operative times and hospital stays, and satisfactory aesthetic outcomes. Additionally, the surgery is performed extra-peritoneally and may not require the use of stents or drains, depending on surgeon preference. Further investigations are being conducted to determine the role of UU in the settings of double collecting systems associated with ipsilateral LP VUR.
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Affiliation(s)
- Maria Veronica Rodriguez
- Urology Department at Doctors Hospital at Renaissance, 5501 S McColl Rd, Edinburg, TX 78539, USA.
| | - Paola Pena
- Pediatric Urology Department of the Hospital Exequiel Gonzalez Cortes, Clínica Alemana, Gran Av. José Miguel Carrera 3300, Av. Vitacura 5951, Santiago, Chile; Clínica Santa Maria, Bellavista 0415, Santiago, Chile.
| | - Eliana Vargas
- Centro de Urología Pediátrica y Especialidades, C. Manuel Rodríguez Objío 26, Santo Domingo, Dominican Republic.
| | - Francisca Yankovic
- Pediatric Urology Department of the Hospital Exequiel Gonzalez Cortes, Clínica Alemana, Gran Av. José Miguel Carrera 3300, Av. Vitacura 5951, Santiago, Chile; Clínica Santa Maria, Bellavista 0415, Santiago, Chile.
| | - Francisco Reed
- Pediatric Urology Department of the Hospital Exequiel Gonzalez Cortes, Clínica Alemana, Gran Av. José Miguel Carrera 3300, Av. Vitacura 5951, Santiago, Chile; Clínica Santa Maria, Bellavista 0415, Santiago, Chile.
| | - Jose R Ovalle
- Centro de Urología Pediátrica y Especialidades, C. Manuel Rodríguez Objío 26, Santo Domingo, Dominican Republic.
| | - Pedro-Jose Lopez
- Pediatric Urology Department of the Hospital Exequiel Gonzalez Cortes, Clínica Alemana, Gran Av. José Miguel Carrera 3300, Av. Vitacura 5951, Santiago, Chile; Clínica Santa Maria, Bellavista 0415, Santiago, Chile.
| | - Luis H Braga
- McMaster University, 1280 Main St W, Hamilton, Ontario, Canada.
| | - Juan C Prieto
- Pediatric Urology Division at Methodist Children's Hospital and Children's Hospital of San Antonio, 7700 Floyd Curl Dr San Antonio, TX 78229, USA.
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Batra NV, Dangle P. A review of robotic-assisted laparoscopic partial nephrectomy in the management of renal duplication anomalies. Front Surg 2024; 11:1364246. [PMID: 38404295 PMCID: PMC10884263 DOI: 10.3389/fsurg.2024.1364246] [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: 01/01/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Open and purely laparoscopic partial nephrectomy or heminephrectomy has been the standard management for renal duplication anomalies for symptomatic children with non-functional renal moieties. While robotic-assisted laparoscopic partial nephrectomy (RALPN) has been established as a safe and feasible option for the management of renal duplex anomalies, there remains a paucity of data on this topic. The aim of this study is to comprehensively review all available outcomes data and update the use of emerging technologies in robotic surgery which continue to make RALPN a viable and advantageous option in the management of renal duplex anomalies.
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Affiliation(s)
- Nikhil Varun Batra
- Riley Hospital for Children at IU Health, Indianapolis, IN, United States
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O'Brien LP, Hannan E, Antao B, Peirce C. Paediatric robotic surgery: a narrative review. J Robot Surg 2023; 17:1171-1179. [PMID: 36645643 PMCID: PMC10374698 DOI: 10.1007/s11701-023-01523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
The benefits of minimally invasive surgery (MIS) compared with traditional open surgery, including reduced postoperative pain and a reduced length of stay, are well recognised. A significant barrier for MIS in paediatric populations has been the technical challenge posed by laparoscopic surgery in small working spaces, where rigid instruments and restrictive working angles act as barriers to safe dissection. Thus, open surgery remains commonplace in paediatrics, particularly for complex major surgery and for surgical oncology. Robotic surgical platforms have been designed to overcome the limitations of laparoscopic surgery by offering a stable 3-dimensional view, improved ergonomics and greater range of motion. Such advantages may be particularly beneficial in paediatric surgery by empowering the surgeon to perform MIS in the smaller working spaces found in children, particularly in cases that may demand intracorporeal suturing and anastomosis. However, some reservations have been raised regarding the utilisation of robotic platforms in children, including elevated cost, an increased operative time and a lack of dedicated paediatric equipment. This article aims to review the current role of robotics within the field of paediatric surgery.
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Affiliation(s)
- Lukas Padraig O'Brien
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland.
| | - Brice Antao
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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Pierangeli F, Bindi E, Cruccetti A, Nino F, Gentilucci G. Robotic-assisted excision of a giant ureteral stump in a child: Case report and Non-systematic review of the Literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Lombardo AM, Gundeti MS. Review of robot-assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning. Int J Urol 2023; 30:250-257. [PMID: 36520939 DOI: 10.1111/iju.15105] [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: 07/02/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
As robotic-assisted (RAL) surgery expanded to treat pediatric congenital disease, infant anatomy and physiology posed unique challenges that prompted adaptations to the technology and surgical technique, which are compiled and reviewed in this manuscript. From the beginning, collaboration with anesthesia is critical for a safe, efficient case including placement of an endotracheal tube rather than a laryngeal mask (LMA) and placement of a nasogastric tube and/or rectal tube to relieve distended stomach or bowel, respectively. Furthermore, end-tidal CO2 (EtCO2 ) is important for monitoring and predicting the effects of pneumoperitoneum on caridiovascular physiology, incranial pressure, and risk of acidosis and hypercarbia. Positioning can further exacerbate these effects and affect intra-abdominal working space. For infant robotic pyeloplasty and heminephrectomy, a "beanbag" is commonly used for stabilization in the lateral decubitus position. We advise against the use of a "baby bump" because it brings the bowels and vasculature more anterior than expected. Pnuemoperitoneum pressure of 8-10 mmHg during port placement maximizes safety, but thereafter, the pneumoperitoneum pressure can be minimized to 6-8 mmHg during the procedure without compromising the visual field. Port sites should be marked after insufflation, followed by the open Hasson technique for peritoneal access and port placement under direct vision with intussusception of the trocars to avoid vascular or bowel injury. Additional tips can be obtained through this manuscript, immersive fellowships, and mini-fellowships. Ulitmately, infant robotic surgery has the potential to benefit many children but is presently limited by the lack of pediatric-specific robotic technology and its associated costs.
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Affiliation(s)
- Alyssa M Lombardo
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mohan S Gundeti
- The University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
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Robotic upper pole heminephrectomy in children – Video demonstration of tips to preserve the normal moiety. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sahadev R, Rodriguez MV, Kawal T, Barashi N, Srinivasan AK, Gundeti M, Shukla AR. Upper or lower tract approach for duplex anomalies? A bi-institutional comparative analysis of robot-assisted approaches. J Robot Surg 2022; 16:1321-1328. [PMID: 35079941 DOI: 10.1007/s11701-022-01372-2] [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: 04/29/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
Optimal management of duplication anomalies may include an upper or lower tract surgical approach. In the contemporary era, the robot-assisted laparoscopic heminephrectomy (RALHN) and robot-assisted laparoscopic ipsilateral ureteroureterostomy (RALIUU) are viable interventions predicated on clinical, institutional and surgeon preferences. We present a multi-institutional comparative analysis aiming to compare the outcomes of RALHN and RALIUU to see if either of the approaches confers an advantage over the other in treating duplex renal anomalies needing intervention. We completed a retrospective review of consecutive children undergoing RALIUU at Hospital A and RALHN at Hospital B from January 2009 to March 2017. The primary outcome was 'surgical success' defined by the resolution of clinical symptoms, improved radiological parameters, and no unplanned subsequent interventions till the time of study completion. Secondary outcomes included operative parameters, complications, and subsequent urinary infections. There were 39 RALIUU and 28 RALHN. Baseline demographic and clinical parameters across two cohorts were similar. The primary outcome of 'surgical success' was 100% across both cohorts. There were no major surgical complications, and the incidence of postoperative urinary tract infection was minimal and similar for both groups. Operative time favored RALHN; blood loss and analgesic requirements were minimal in both cohorts. Both RALIUU and RALHN are definitive surgical interventions in children with complex duplex moieties, delivering satisfactory surgical outcomes with a low complication profile and marginal differences in the postoperative patient outcomes. This pilot bi-institutional study provides the basis for a larger collaboration to further define optimal techniques, standardize surgical care pathways, and interrogate long-term outcomes.
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Affiliation(s)
- Ravindra Sahadev
- Pediatric Urology, Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA.
| | - Maria Veronica Rodriguez
- Pediatric Urology, University of Chicago Medicine Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - Trudy Kawal
- Pediatric Urology, Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA
| | - Nimrod Barashi
- Pediatric Urology, University of Chicago Medicine Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - Arun K Srinivasan
- Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA
| | - Mohan Gundeti
- University of Chicago Medicine Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - Aseem R Shukla
- Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA
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Chertin L, Neeman BB, Stav K, Noh PH, Koucherov S, Gaber J, Zisman A, Chertin B, Dubrov V, Bondarenko S, Neheman A. Robotic versus laparoscopic ipsilateral uretero-ureterostomy for upper urinary tract duplications in the pediatric population: A multi-institutional review of outcomes and complications. J Pediatr Surg 2021; 56:2377-2380. [PMID: 33468310 DOI: 10.1016/j.jpedsurg.2020.12.022] [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: 11/21/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To review and compare robotic ipsilateral uretero-ureterostomy (RIUU) and laparoscopic ipsilateral uretero-ureterostomy (LIUU) in terms of safety, efficacy, and outcomes. MATERIALS AND METHODS A retrospective chart review, including all pediatric patients who underwent RIUU and LIUU at 5 different medical centers, between 2015 and 2019, was performed. Patient's demographics, perioperative data, surgical techniques, complications, and results were compared. RESULTS The study included 66 pediatric patients, 22 RIUU and 44 LIUU. Median age at surgery was 12 month (IQR 7-52) and median weight was 12 kg (IQR 9-16). Upper to lower IUU was performed in 55 cases and lower to upper IUU in 11 cases. Median operative times for RIUU and LIUU were 90 min (IQR 75-97.5) and 112.5 min (IQR 81.5-121.25), respectively (p = 0.034). Clavien-Dindo grade 3 postoperative complications occurred in two LIUU patients. One patient underwent an ancillary procedure with laparoscopic distal ureteral stump removal. All patients had resolution of symptoms and improvement in hydronephrosis or a non-obstructed curve on MAG3 diuretic renal scan. CONCLUSION RIUU and LIUU are both safe and effective minimally invasive approaches for duplex upper urinary tract anomalies in the pediatric population. RIUU demonstrated shorter operating times .
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Affiliation(s)
- Leon Chertin
- Department of Urology, Shamir Medical Center, Zerifin, Israel.
| | - Binyamin B Neeman
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Paul H Noh
- Department of Pediatric Urology, Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Stanislav Koucherov
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jaudat Gaber
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Boris Chertin
- Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Vitaly Dubrov
- Department of Pediatric Urology, Children's City Clinical Hospital, Minsk, Republic of Belarus
| | - Sergey Bondarenko
- Department of Pediatric Urology, Municipal Hospital, Volgograd, Russian Federation
| | - Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel
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Zhu X, Wang J, Zhu H, Huang L, Chen C, Wang L, Dong J, Ge Z, Ma G, Guo Y, Huang S. Lich-Gregoir vesico-ureteral reimplantation for duplex kidney anomalies in the pediatric population: a retrospective cohort study between laparoscopic and open surgery. Transl Pediatr 2021; 10:26-32. [PMID: 33633934 PMCID: PMC7882287 DOI: 10.21037/tp-20-163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The aim of the study is to compare the Lich-Gregoir vesico-ureteral reimplantation in laparoscopy and open surgery. METHODS In this case control study, we enrolled pediatric patients who were diagnosed with unilateral duplex kidney and had underwent surgical treatment. The surgical treatments were either conventional open surgery or laparoscopic surgery. We collected the basic demographic data and extracted the operative-related statistics such as operation time, blood loss, length of hospital stay, pain level, and post-operative complications. The two groups were compared using Student's t-test. RESULTS A total of 90 subjects were enrolled. Of the enrolled subjects, 35 underwent open surgery and 55 underwent laparoscopic surgery. There were no observable difference in the basic demographics between two groups (P>0.05). The duration of operation in laparoscopic surgery group was significantly shorter than in the open surgery group (95.60±5.25 vs. 108.70±3.12 min, P=0.040). It was also noted that the amount of blood loss, length of hospital stay, drainage level, and the mean visual analog scale in laparoscopic group were significantly lower (P<0.05). The total incidence of complications in the laparoscopic and open surgery groups were 16.36% and 37.14%, respectively. CONCLUSIONS Laparoscopic Lich-Gregoir vesico-ureteral reimplantation surgery management can be successful, clinically effective, and safe for pediatric population with functional duplex kidneys, and is better than the open surgery techniques.
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Affiliation(s)
- Xiaojiang Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Haobo Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Liqu Huang
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Chenjun Chen
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lixia Wang
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Dong
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng Ge
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Geng Ma
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yunfei Guo
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Songming Huang
- Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Roshan A, MacNeily AE. Dorsal lumbotomy for pediatric upper pole hemi-nephrectomy: Back (door) to the future? J Pediatr Urol 2020; 16:480.e1-480.e7. [PMID: 32536569 DOI: 10.1016/j.jpurol.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Upper pole heminephrectomy (UHN) is performed for two main indications in children: ectopic ureterocele and duplication anomalies with upper pole ectopy, both in the context of a poorly functioning upper pole moiety. Current popular techniques for conducting UHN include laparoscopic (LPN) and robot-assisted laparoscopic (RAPN). OBJECTIVE To evaluate outcomes following dorsal lumbotomy (DL), an open approach used historically for pyeloplasty and pyelolithotomy, and in which no clinical trials or exclusive case-series have been conducted for upper pole hemi-nephrectomy (UHN) in children. We ultimately aim to compare our outcomes following DL at our centre to that of published outcomes of minimally invasive approaches to UHN. STUDY DESIGN Institutional board review was obtained (H18-03716) for a retrospective review of 50 UHN performed in 49 consecutive pediatric patients using the DL approach by a single surgeon between 2001 and 2019. Clinical variables and indicators included age, sex, weight, skin-to-skin time, total operating room time, duration of hospital stay, post-operative complications, analgesic requirements, and post-operative ultrasound results. RESULTS Of 50 UHN performed, 23 had a presurgical diagnosis of ectopic ureter, and 27 ureterocele. Mean weight of patients was 12.61 kg, and the mean age at surgery was 24.55 months. Mean (range) for time between skin incision and closure was 88.5 (62-132) minutes, and the mean (range) total operating room time was 138.5 (70-180) minutes. There were neither intraoperative complications nor transfusions. The mean (range) post-operative opioid delivered was 0.73 (0.00-2.00) mg/kg/day. Mean (range) post-operative ibuprofen delivered was 5.41 (0.00-37.73) mg/kg/day. Median length of hospital stay was 2 days. No patient received post-operative prescriptions for narcotics at discharge. There were no wound complications. One patient had secondary atrophy of the lower pole. Secondary lower tract surgery, unrelated to surgical approach, was performed in five patients. Ten patients experienced a urinary tract infection at some point after surgery. CONCLUSION DL is safe, feasible, and produces operative outcomes and times comparable to that of laparoscopic and robotic techniques. These findings as well as operative costs should be considered when selecting a surgical technique for UHN.
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Affiliation(s)
- Aishwarya Roshan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A E MacNeily
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Urologic Sciences, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
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12
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Andolfi C, Gundeti MS. Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience. Investig Clin Urol 2020; 61:S51-S56. [PMID: 32055754 PMCID: PMC7004838 DOI: 10.4111/icu.2020.61.s1.s51] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/12/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Live case demonstrations have become a common occurrence at surgical meetings around the world. These demonstrations are meant to serve as an educational medium for teaching techniques, promote discussion, improve interventions and outcomes. Despite the valuable educational benefits, many authors still question the ethics of this approach. We present our 8-year experience in live surgery, discuss the ethical issues, and provide recommendations. Materials and Methods We reviewed records of patients who underwent live robotic surgery during broadcasting events. Procedures performed were robot-assisted laparoscopic pyeloplasty (RAL-P), ureteral reimplantation (RALUR), and hemi-nephrectomy (RAL-HN). Peri- and post-operative outcomes were compared to our previously published case series. Results From October 2011 to May 2019, the senior author (MSG) performed all live surgery demonstrations on 22 patients: 9 RAL-P, 9 RALUR, and 4 RAL-HN. Live RAL-Ps had a 100% success rate and lower 30-day Clavien-Dindo grade (CDG) III complications when compared to our previous case series (11.1% vs. 21.2%). RALURs performed during live demonstrations had a higher success rate than our previously published cohort (100% vs. 82%). RAL-HN operative time and length of stay were comparable to our non-live control group. Conclusions Live surgery is a valuable didactic tool, but even experienced surgeons may be adversely affected by inappropriate case selection, technical difficulty, and anxiety associated with particular settings, such as operating at different institutions or working with unfamiliar surgical teams. We suggest consultation of an ethics review board and formulation of standard guidelines for patient selection, surgical equipment, and operative team.
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Affiliation(s)
- Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, USA
| | - Mohan S Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, USA
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Zaccaria L, Fichtenbaum EJ, Minevich EA, Schulte ME, Noh PH. Long-Term Follow-Up of Laparoendoscopic Single-Site Partial Nephrectomy for Nonfunctioning Moieties of Renal Duplication and Fusion Anomalies in Infants and Children. J Endourol 2019; 34:134-138. [PMID: 31760801 DOI: 10.1089/end.2019.0393] [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: 10/25/2022] Open
Abstract
Objectives: To report on long-term follow-up and outcomes of infants and small children who have undergone laparoendoscopic single-site (LESS) partial nephrectomy to manage upper urinary tract duplication and fusion anomalies. Materials and Methods: A retrospective review was performed evaluating outcomes of pediatric patients who underwent LESS partial nephrectomy for upper urinary tract duplication and fusion anomalies from January 2012 to July 2015, by a single surgeon at a tertiary pediatric referral center. Demographic and perioperative data were reviewed as well as follow-up imaging. Descriptive statistics were used for analysis. Results: A total of 18 patients were identified. Additional access was used for two patients to complete the procedure. Median follow-up was 39 months. No short-term complications were encountered. Three patients were noted to have abnormal postoperative ultrasounds: two perinephric fluid collections and one atrophy of the remaining ipsilateral moiety. One fluid collection resolved completely, and the other decreased in size. Complete atrophy of the ipsilateral moiety occurred. No secondary procedures were required. Conclusions: LESS partial nephrectomy is safe for renal duplication and fusion anomalies with good long-term outcomes. Although it can be safely performed, it is a technically demanding procedure and has been discontinued in favor of robotic partial nephrectomy.
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Affiliation(s)
- Laura Zaccaria
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eric J Fichtenbaum
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eugene A Minevich
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marion E Schulte
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
The use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in many fields in adult surgery, such as sentinel lymph node mapping, intra-operative solid tumor identification, and organ perfusion assessment. However, the clinical application of ICG in pediatric surgery is just at the beginning. This review paper presents the advantages, current applications and potential developments of NIR fluorescence imaging with ICG in our field.
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Affiliation(s)
- C T Lau
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - D M Au
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - K K Y Wong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.
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Varda BK, Rajender A, Yu RN, Lee RS. A contemporary single-institution retrospective cohort study comparing perioperative outcomes between robotic and open partial nephrectomy for poorly functioning renal moieties in children with duplex collecting systems. J Pediatr Urol 2018; 14:549.e1-549.e8. [PMID: 30172696 DOI: 10.1016/j.jpurol.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/04/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Studies evaluating robotic-assisted laparoscopic partial nephrectomy (RALPN) are limited to case series, amounting to a lack of studies directly comparing perioperative outcomes for RALPN to open partial nephrectomy (OPN). OBJECTIVE To compare perioperative outcomes between RALPN and OPN. METHODS A single-institution, retrospective cohort study was performed to compare perioperative outcomes (operative time (OT), length of stay (LOS), complications, readmissions, postoperative interventions, loss in size of the residual moiety, and the presence of postoperative 'contained fluid collections') for RALPN and OPN between February 2007 and July 2014. Descriptive statistics were calculated and unadjusted analyses performed, including Chi-squared/Fisher's exact for categorical variables and Wilcoxon rank sum for continuous variables. RESULTS During the study period, 43 partial nephrectomies were performed for benign disease: 27 (63%) RALPN and 16 (37%) OPN. The RALPN cohort was significantly older than the OPN cohort (3.5 vs. 0.8 years; P = 0.003). The cohorts were otherwise similar regarding race, American Society of Anesthesiologist score (ASA), affected moiety, laterality, associated anomalies, moiety function, and surgical indication. Robotic-assisted laparoscopic partial nephrectomy was associated with a significantly shorter LOS (1 vs. 3 days; P = 0.002). Operative time and complication rates were comparable. The OPN group had a longer median follow-up (2.7 years vs. 1.1; P = 0.03). No differences were observed between the cohorts for readmissions, postoperative interventions, loss in size of residual moiety, or development of 'contained fluid collections'. These outcomes are reported in the Summary Table. 'Contained fluid collections' occurred more frequently after lower pole resections (73% vs. 30%; P = 0.009). DISCUSSION This study is one of the few to directly compare RALPN to OPN, and demonstrated that RALPN has comparable (if not better) outcomes than OPN. In particular, RALPN provides the advantage of a shorter LOS. Avoiding the flank incision used in OPN may also offer reduced pain; however, this was not studied here and the literature provides weak evidence for this effect. This unadjusted analysis may have been confounded by its short median follow-up and significantly younger OPN cohort. CONCLUSION In this contemporary comparative analysis, RALPN predicted a similar median OT and safety profile to OPN while offering the advantage of a shorter LOS. Regardless of surgical cohort, there were no adverse effects on the residual renal moieties and postoperative 'contained fluid collections' occurred with notable frequency and were independently associated with lower pole pathology.
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Affiliation(s)
- B K Varda
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - A Rajender
- Department of Urology, Boston Medical Center, Boston, MA, USA
| | - R N Yu
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - R S Lee
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW In this review, we summarize research that has evaluated the role of laparoendoscopic single-site (LESS) and robotic surgery in pediatric urology, highlighting new and/or controversial ideas. RECENT FINDINGS The newest research developments over the last several years are studies that address generalizability of these techniques, ideal patient factors, extrapolation to more complex surgeries, and comparative studies to more traditional techniques to define the associated costs and benefits, as well as patient-centered outcomes. Specifically in the field of LESS, addressing the limitations of suboptimal vision, instrument crowding, and loss of triangulation have been a focus. The literature is now replete with new applications for robotic surgery as well as descriptions of the specific technical challenges inherent to pediatrics. Robotic surgery and LESS are areas of growth in pediatric urology that allow continual innovation and expansion of technology within a surgeon's armamentarium.
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17
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Clement K, Hendry J, Keeley FX, Aboumarzouk OM. Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis. Urol Int 2017; 101:1-6. [PMID: 29224026 DOI: 10.1159/000485466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Duplex collecting system of the kidney is a relatively common abnormality, with the majority of symptomatic cases discovered in childhood. Treatment is commonly a heminephrectomy of the affected moiety. We aimed to conduct a systematic review of the literature to provide the best available evidence for heminephrectomy for duplex kidneys in the adult population. MATERIALS AND METHODS A literature search was conducted in September 2017 with no limitations being placed on language, region, date or publication type. Data were represented numerically and analysed cumulatively. RESULTS Seven retrospective studies with 66 patients were included. Of which, 56/66 operations were performed laparoscopically, 5/66 were robot-assisted and 5/66 were open procedures. Complete resolution of symptoms was reported in 53/55 (96.4%) of patients in five studies providing outcome data. Of the 6 studies reporting complications, there were a total of 9 complications (9/62, 14.5%), however 5 of these were found to be in one study alone. CONCLUSIONS This review emphasises the scarcity of evidence for heminephrectomy in adults. Nonetheless, it has been shown that this operation may be effective in alleviating patients' symptoms in addition to being safe in experienced hands.
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Affiliation(s)
- Keiran Clement
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jane Hendry
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Francis X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Omar M Aboumarzouk
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom.,University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, United Kingdom.,Islamic Universities of Gaza, College of Medicine, Gaza, Palestina
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18
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Ballouhey Q, Binet A, Clermidi P, Braik K, Villemagne T, Cros J, Lardy H, Fourcade L. Partial nephrectomy for small children: Robot-assisted versus open surgery. Int J Urol 2017; 24:855-860. [PMID: 29027269 DOI: 10.1111/iju.13466] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/25/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To compare the outcomes of robot-assisted heminephrectomy for duplex kidney in children with those of open heminephrectomy. METHODS The present retrospective multicentric analysis reviewed the records of robot-assisted versus open heminephrectomy carried out for duplex kidney in children from 2007 to 2014. Demographic data, weight, surgical time, hospital stay, complications and outcome were recorded. Follow up was based on a clinical review, renal sonography and dimercaptosuccinic acid renal scintigraphy. RESULTS A total of 15 patients underwent robot-assisted heminephrectomy, and 13 patients underwent retroperitoneal heminephrectomy by open approach. All patients weighed <15 kg. The mean age at the time of surgery was 20.2 months (range 7-39 months) in the robotic group, and 18.4 months (range 6-41 months) in the open group. The mean hospital stay was statistically longer for the open surgery group (6.3 days, range 5-8 days vs 3.4 days, range 1-7 days; P < 0.001). Regarding postoperative pain control, total morphine equivalent intake was statistically greater for the open group (0.52 mg/kg/day vs 1.08 mg/kg/day; P < 0.001). No patient lost the remaining healthy moiety. There was no significant difference in terms of operating time, complication rate or renal outcomes. CONCLUSIONS Robot-assisted heminephrectomy in small children seems to offer comparable renal outcomes with those of its standard open surgery counterpart. Specific technical adjustments are necessary, which typically increase the set-up time.
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Affiliation(s)
- Quentin Ballouhey
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Pauline Clermidi
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Karim Braik
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Thierry Villemagne
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Jérôme Cros
- Department of Pediatric Anesthesiology, Limoges University Hospital, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
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Lopes RI, Fernandez N, Koyle MA, Dos Santos J, Perez J, Romao R, Lorenzo AJ. Clinical Outcomes of the Upper Urinary Tract after Ureteral Clipping for Treatment of Low Functioning or Nonfunctioning Renal Moieties. J Urol 2017; 199:558-564. [PMID: 28943272 DOI: 10.1016/j.juro.2017.09.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A growing body of evidence suggests that it is safe to ligate the ureter of poorly functioning renal moieties during renal transplantation. We present clinical outcomes and data on hydronephrosis progression in pediatric cases associated with ectopic ureters and obstructive ureteroceles. MATERIALS AND METHODS We prospectively collected data for 35 consecutive patients (23 females and 12 males) who underwent ureteral clipping between February 2011 and August 2016. Patients were divided into 4 groups consisting of 1) duplex system with ectopic ureter (45.7%), 2) duplex system with a large ureterocele (11.4%), 3) other duplex system (8.6%) and 4) single system kidneys (34.3%). Patients were followed for clinical outcomes and hydronephrosis trends. Comparisons included preoperative and postoperative anteroposterior diameter, maximal ureteral diameter and ureterocele size. RESULTS Median age at surgery was 59 months (IQR 11 to 120, range 5 to 216). Median ± SD operative time was 108.9 ± 31.1 minutes (range 20 to 180) and median length of stay was 7.5 hours (IQR 6 to 19, range 5 to 336). Immediate resolution of urinary incontinence was observed in all 16 ectopic ureter cases. After a median ± SD followup of 20.8 ± 13.8 months (IQR 8.5 to 30, range 6 to 50) 97.2% of the patients remained asymptomatic. No significant differences were observed between initial and last anteroposterior diameter measurements except in group 1 (p = 0.001). All ureteroceles demonstrated a significant decrease in median ± SD size after clipping (from 2.7 ± 0.41 to 0.53 ± 0.92 cm, p = 0.003). Pyonephrosis developed in 1 patient, who underwent laparoscopic nephrectomy. CONCLUSIONS Ureteral clipping appears to be a reasonable, safe and effective option for pediatric patients in the reported settings, with the potential to be simpler and quicker than extirpative or reconstructive procedures.
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Affiliation(s)
- Roberto Iglesias Lopes
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Nicolas Fernandez
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogota, Colombia
| | - Martin A Koyle
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jaime Perez
- Division of Urology, Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogota, Colombia
| | - Rodrigo Romao
- Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Upper Pole Heminephrectomy Versus Lower Pole Ureteroureterostomy for Ectopic Upper Pole Ureters. Curr Urol Rep 2017; 18:21. [DOI: 10.1007/s11934-017-0664-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Till H, Basharkhah A, Hock A. What's the best minimal invasive approach to pediatric nephrectomy and heminephrectomy: conventional laparoscopy (CL), single-site (LESS) or robotics (RAS)? Transl Pediatr 2016; 5:240-244. [PMID: 27867846 PMCID: PMC5107386 DOI: 10.21037/tp.2016.09.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Conventional laparoscopy (CL) using 3-5 mm ports has become the goldstandard for pediatric nephrectomy (N), heminephrectomy (HN) and heminephrecto-ureterectomy (HNU) for many years now. Recently the spectrum of minimal invasive surgery (MIS) has been extended by variants like laparoendoscopic single-site surgery (LESS) or robot-assisted surgery (RAS). However such technical developments tend to drive surgical euphoria and feasibility studies, but may miss adequate academic research about function and proven patients' benefits. This article delivers a comprehensive analysis of present pediatric studies comparing at least two MIS approaches to N, HN and HNU. METHODS A systematic literature-based search for studies published between 2011-2016 about CL versus LESS or RAS for pediatric N, HN, and HNU was performed using multiple electronic databases and sources. The level of evidence was determined using the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. Single arm observational studies about N, HN or HNU using CL, LESS or RAS as well as publications including adult patients were excluded. RESULTS A total of 11 studies met defined inclusion criteria, reporting on CL versus LESS or RAS. No studies of OCEBM Level 1 or 2 were identified. Performing CL for N and HN limited evidence indicated reduced analgesic requirements and shorter hospital stay over open surgery, but longer operating time. Preservation of renal function of the remaining moiety after CL-HN was 95%. Importantly, of patients losing their remaining moiety, median age at surgery was 9 months (range, 4-42 months), and all except 1 (6/7) had an upper pole HN. Several authors compared TNP versus RPN access for CL and confirmed a longer operating time for RPN versus TPN-NU. Moreover one study reported a longer ureteric stump in RPN versus TPN-HNU (range, 2-5 cm vs. 3-7 mm). Disadvantages of LESS or RAS over CL were longer operative time and higher total costs (RAS). There were no differences regarding complications, success rates, or short-term outcomes between pediatric RAS versus CL. No long-term studies about preservation of renal function or length of ureteric stump using LESS or RAS could be retrieved. CONCLUSIONS Several approaches to MIS-NU and HNU are available today. CL represents the method of choice for any age group. TPN or RPN can be chosen according to age of the patient. LESS and RAS offer distinct advantages, but also lack evident patients' benefits over CL at present. Hopefully, as pediatric MIS advances over the next decade, larger studies comparing CL, LESS or RAS directly for pediatric NU and HNU will be published to gain a higher level of evidence what's really best for the child.
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Affiliation(s)
- Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Ali Basharkhah
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Andras Hock
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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22
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Herz D, DaJusta D, Ching C, McLeod D. Segmental arterial mapping during pediatric robot-assisted laparoscopic heminephrectomy: A descriptive series. J Pediatr Urol 2016; 12:266.e1-6. [PMID: 27321559 DOI: 10.1016/j.jpurol.2016.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/30/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The incidence of innocent moiety injury during heminephrectomy is estimated to be 4-5%. This complication can have long-term consequences for the child. Selective arterial mapping (SAM) with indocyanine green (ICG)-aided near infrared fluorescence (NIRF) imaging using the Firefly™ system on the da Vinci(®) surgical robotic console has proven to be valuable in robotic partial nephrectomy for adult renal tumors. However, there is nothing in the literature for using this technique in pediatric robot-assisted laparoscopic heminephrectomy (RALHN). OBJECTIVE To present a descriptive series of children who had SAM RALHN using ICG-aided NIRF imaging. To determine the feasibility of using ICG-aided NIRF SAM during RALHN, and to study if real-time delineation of the selective arterial anatomy of the upper and lower moieties would be helpful or change the immediate outcomes of the surgery. STUDY DESIGN A descriptive series of six children who received RALHN at the present institution. RESULTS Selective arterial mapping was performed safely without toxicity or vascular complications; it did not extend the operative time and did not change the complexity of the operation. As shown in the summary table below, SAM added value by increasing safety of the operation. The individual operation cost increase of using SAM was only related to the single-use vial of ICG. DISCUSSION Inadvertent injury to the innocent moiety in pediatric heminephrectomy is seldom noted intraoperatively, and many times only becomes evident postoperatively when there is acute ischemia or a chronic reduction in renal function. Although there is no replacement for good surgical technique and judgment, SAM during RALHN is a useful real-time way of alerting the surgeon to unexpected anatomy, and possible unintended or occult injury to the innocent moiety that could have devastating short-term and long-term consequences to the child, despite immediate recovery from surgery. CONCLUSIONS This report achieved its aim of reporting the feasibility of SAM on a small descriptive series of children who had RALHN.
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Affiliation(s)
- D Herz
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - D DaJusta
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - C Ching
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - D McLeod
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, 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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