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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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2
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Tesoro S, Gamba P, Bertozzi M, Borgogni R, Caramelli F, Cobellis G, Cortese G, Esposito C, Gargano T, Garra R, Mantovani G, Marchesini L, Mencherini S, Messina M, Neba GR, Pelizzo G, Pizzi S, Riccipetitoni G, Simonini A, Tognon C, Lima M. Pediatric robotic surgery: issues in management-expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP). Surg Endosc 2022; 36:7877-7897. [PMID: 36121503 PMCID: PMC9613560 DOI: 10.1007/s00464-022-09577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. METHODS A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. RESULTS During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. CONCLUSION Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.
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Affiliation(s)
- Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy.
| | - Mirko Bertozzi
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Fabio Caramelli
- Anesthesia and Intensive Care Unit, IRCCS Sant'Orsola Polyclinic, Bologna, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Polytechnical University of Marche, Ancona, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Tommaso Gargano
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Rossella Garra
- Institute of Anesthesia and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giulia Mantovani
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Laura Marchesini
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Simonetta Mencherini
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS San Matteo Polyclinic, Pavia, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Santa Maria Alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Gerald Rogan Neba
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi' Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Simone Pizzi
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Alessandro Simonini
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Costanza Tognon
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Mario Lima
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
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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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Chu H, Zhang XS, Cao YS, Deng QF. A single-center study of two types of upper kidney preservation surgery for complete duplicated kidney in children. Front Pediatr 2022; 10:1056349. [PMID: 36601034 PMCID: PMC9806208 DOI: 10.3389/fped.2022.1056349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objectives of this study were to compare the efficacy, advantages, and disadvantages of insertable ureteral reimplantation (UC group) and ureteral end-to-side anastomosis (UU group) in the treatment of duplicated kidney and summarize the clinical experience in its diagnosis and treatment. METHODS The current retrospective study enrolled 20 cases with duplicated kidney in Anhui Provincial Children's Hospital from April 2016 to June 2021, including 11 in the UC group and 9 in the UU group. There were 8 boys and 12 girls, with 12 on the left side and 8 on the right side. Meanwhile, there were three cases with urinary tract infection and nine with urinary incontinence. The rest of them were found by B ultrasound during physical examination. The median age of these patients was 33.5 months. Later, preoperative and postoperative renal pelvis separation, ureteral dilation, operation time, and drainage tube indwelling time were compared between the two groups. RESULTS There were statistically significant differences in operation time (282 ± 50.55 vs. 176 ± 61.92, P = 0.03), drainage time (9.36 ± 5.00 vs. 5.33 ± 1.22, P = 0.02), and hospital stay (22.18 ± 5.40 vs. 14.78 ± 5.33, P = 0.007) between the two groups. In addition, the degree of hydronephrosis (UC: 1.86 ± 0.93 vs. 1.08 ± 0.77, P = 0.00; UU: 1.8 ± 0.95 vs. 0.89 ± 0.60, P = 0.02) and ureteral dilatation (UC: 1.57 ± 0.30 vs. 0.72 ± 0.22, P = 0.00; UU: 1.47 ± 0.50 vs. 0.88 ± 0.22, P = 0.001) were statistically different between the two groups before and after surgery. CONCLUSION Compared with the UC method, the UU method has the advantages of less trauma, faster recovery, and fewer complications. Double J tube or ureter stent placement is beneficial for finding and protecting the lower ureter intraoperatively, without increasing the difficulty in operation, which can also prevent anastomosis or ureteral orifice stenosis.
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Affiliation(s)
- Han Chu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui, China.,Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xian-Sheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Yong-Sheng Cao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Qi-Fei Deng
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
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Wakimoto M, Michalsky M, Nafiu O, Tobias J. Anesthetic Implications of Robotic-Assisted Surgery in Pediatric Patients. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2021; 8:9-19. [PMID: 34079838 PMCID: PMC8164723 DOI: 10.2147/rsrr.s308185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
The novel technology of robotic-assisted surgery (RAS) has been utilized in children for the past two decades with several potential clinical benefits including reduction of postoperative pain, shortened hospital length of stay, and improved cosmetic outcomes. While associated costs and the limitations regarding instruments for smaller pediatric patients remain relevant issues, surgeon comfort related to ergonomic design in combination with enhanced three-dimensional high-fidelity imaging and tissue handling compared to traditional minimally invasive approached may offer improved surgical and postoperative outcomes. Given that the demand for this innovative technology will likely continue to expand in the field of pediatric surgery, pediatric anesthesiologists will be called upon to provide anesthetic care to patients exposed to this novel surgical technology with its unique features, intraoperative requirements, and potential complications. The current manuscript provides a narrative review of robotic-assisted surgery and discusses important anesthetic considerations and potential complications of these techniques.
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Affiliation(s)
- Mayuko Wakimoto
- Department of Anesthesiology, Osaka Police Hospital, Osaka, Japan
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH, USA
| | - Olubukola Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH, USA
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Manjunath DA, Radhakrishna V, Vepakomma D. Transureteroureterostomy in children: a retrospective study. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:163-169. [PMID: 34079848 PMCID: PMC8165706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Transureteroureterostomy (TUU) is a urinary reconstructive procedure seldom used but has a role when conventional reconstructive techniques are not possible. However, the concern is whether it places the opposite, non-diseased ureter and kidney at risk. Hence a retrospective study was conducted to evaluate indications, methods, and outcomes of transureteroureterostomy in children. The study included seven children who underwent TUU between January 2011 and December 2015. The mean age of the study group was 4.5 ± 2.9 years. Six (86%) patients were males. Two patients had primary bladder diverticulum, two posterior urethral valves, two cases of vesico-ureteric reflux, and one had a persistent urogenital sinus. All patients presented with recurrent urinary tract infections. Three (43%) patients had bladder outlet obstruction. Four (57%) patients underwent left to right TUU with right ureteric reimplantation. Two (29%) patients underwent an additional procedure. No complications were found. The key to a good outcome in TUU is case selection. Surgical technique plays a very important role in ensuring good long-term outcome without compromising the normal moiety.
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Affiliation(s)
- Darshan A Manjunath
- Department of General Surgery, McGann Hospital, Shivamogga Institute of Medical SciencesShivamogga, Karnataka, India
| | - Veerabhadra Radhakrishna
- Department of Pediatric Surgery, Bangalore Medical College and Research InstituteBengaluru, India
| | - Deepti Vepakomma
- Department of Pediatric Surgery, Bangalore Medical College and Research InstituteBengaluru, India
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Lee JLY, Wong YS, Pang KKY, Tam YH. Robot‐assisted laparoscopic ipsilateral ureteroureterostomy in children with renal duplex. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph Long Yiu Lee
- Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong
| | - Yuenshan Sammi Wong
- Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong
| | - Kristine Kit Yi Pang
- Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong
| | - Yuk Him Tam
- Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong
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O'Connor E, Teh J, Lawrentschuk N. Robot-assisted ipsilateral ureteroureterostomy in a duplex system utilizing intraoperative flexible ureteroscopy. Urol Case Rep 2020; 31:101158. [PMID: 32280594 PMCID: PMC7139107 DOI: 10.1016/j.eucr.2020.101158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
Abstract
Iatrogenic injury to the ureter during pelvic surgery is an uncommon but well-documented complication. Accurate identification of the ureter during pelvic surgery is made far more complex in the presence of a duplex or ectopic system, an anomaly occurring in up to 2% of the population. In this article we present a technique for robot-assisted ipsilateral ureteroureterostomy for treatment of iatrogenic injury of a lower pole moiety ureter in a complete duplex system.
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Affiliation(s)
- Ellen O'Connor
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Corresponding author. Department of Urology, Austin Hospital, Level 8 Harold Stokes Building, 145 Studley Rd, Heidelberg, VIC, 3084, Australia. Ellen.O'
| | - Jiasian Teh
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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Kalantan SA, Moazin MS, Aldhaam NA, Almousa SA. Patient with duplex ureter injury underwent robot assisted laparoscopic common sheath ureteral reimplantation single docking: Case report. Urol Case Rep 2019; 29:101090. [PMID: 31908958 PMCID: PMC6938932 DOI: 10.1016/j.eucr.2019.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022] Open
Abstract
Ureteral injury is common complication that need comprehensive understanding of ureteral injury management from minimal invasive intervention to ureteral reimplant in both early and late presentation. However, ureteral injury in duplex system rarely reported in literature. Here we are sharing our techniques and challenging in a patient who had a duplex ureteral injury with late presentation underwent robot assisted ureteral reimplantation.
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Affiliation(s)
| | - Maher S Moazin
- National Robotic Surgery Director for Minister of Health, Urology Resident Program, Urology Robotic Surgery & Minimal Invasive Surgery Director King Fahad Medical City, Consultant Andrology & Male Infertility, Neuro-urologist & Voiding Dysfunction, King Saud University for Health Science, P.O. Box 59046, 11425, Riyadh, Saudi Arabia
| | - Naif A Aldhaam
- King Fahad Medical City, Urology Department, P.O. Box 59046, 11525, Saudi Arabia
| | - Saud A Almousa
- King Fahad Medical City, P.O. Box 390202, 11365, Riyadh, Saudi Arabia
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Zukunftsprägende Entwicklungen in der Kinderurologie. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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