468 PEDIATRIC LAPAROSCOPIC PYELOPLASTY AND ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY A COMPARATIVE SINGLE-INSTITUTION STUDY

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2012468 PEDIATRIC LAPAROSCOPIC PYELOPLASTY AND ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY A COMPARATIVE SINGLE-INSTITUTION STUDY Edward Riachy, W. Robert Defoor, Pramod P. Reddy, Eugene A. Minevich, Shumyle Alam, and Paul H. Noh Edward RiachyEdward Riachy Cincinnati, OH More articles by this author , W. Robert DefoorW. Robert Defoor Cincinnati, OH More articles by this author , Pramod P. ReddyPramod P. Reddy Cincinnati, OH More articles by this author , Eugene A. MinevichEugene A. Minevich Cincinnati, OH More articles by this author , Shumyle AlamShumyle Alam Cincinnati, OH More articles by this author , and Paul H. NohPaul H. Noh Cincinnati, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.536AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic pyeloplasty (LP) and robotic-assisted laparoscopic pyeloplasty (RALP) to treat uretero-pelvic junction obstruction (UPJO) in children have been performed as an alternative to open pyeloplasty. The purpose of this study to is report our experience and compare the outcomes between these minimally invasive procedures. METHODS A retrospective cohort study was performed of all patients who underwent LP and RALP for UPJO at a pediatric institution from October 2007 to March 2011. Patient demographics, radiographic imaging, intra-operative details, and surgical outcomes were abstracted from the medical record. Indications for surgery were symptomatic obstruction, increasing grade of hydronephrosis in consecutive renal ultrasounds, or abnormal diuretic renal scan. A successful outcome was defined as absence of clinical symptoms, improvement of the drainage curve on diuretic renal scan, improvement of hydronephrosis on ultrasound, or stable ultrasound with resolution of symptoms. RESULTS We identified 51 patients who underwent 52 dismembered pyeloplasties (32 male, 19 female). RALP was performed on 33 patients (18 left, 15 right). LP was performed on 19 patients (9 left, 10 right). None had conversion to open surgery. Median age was 10 years for children with RALP (range, 19 months - 22 years), and 7 years for those with LP (range, 3 months - 18 years), p=0.09. Median weight was 40.7 Kg for children with RALP (range, 11 - 90), and 30.3 Kg for those with LP (range, 6-71), p=0.06. The median operative time was 227 minutes in RALP (range, 114 - 540) and 274 minutes in LP (range, 145 - 387), p=0.02. The median length of hospital stay was 2 days in RALP (range, 1 - 6) and 1.63 days in LP (range, 1 - 4), p=0.15. The median follow-up period was 17 months (range, 5 - 29) for patients with RALP, and 33 months (range, 5 - 46) for those with LP (p<0.01). Renal ultrasound showed a post-operative improvement of the hydronephrosis in 27 patient with RALP (82%) and 15 with LP (79%), and remained stable in 6 with RALP (18%) and 4 with LP (21%); p=0.53. Post-operative diuretic renal scans were performed on only 2 patients with RALP (6%), and 8 with LP (42%) and all demonstrated an improved drainage curve. The overall success rate was 100% for patients with RALP and 95% for those with LP (consisted of one patient with residual pain); p=0.36. The complication rate was 3% (n=1) in the RALP and 10% (n=2) in the LP group (p=0.54). CONCLUSIONS RALP and LP are both effective techniques to correct UPJO. RALP has a shorter operative time, but its success and complication rates are comparable to LP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e191-e192 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edward Riachy Cincinnati, OH More articles by this author W. Robert Defoor Cincinnati, OH More articles by this author Pramod P. Reddy Cincinnati, OH More articles by this author Eugene A. Minevich Cincinnati, OH More articles by this author Shumyle Alam Cincinnati, OH More articles by this author Paul H. Noh Cincinnati, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...