765 ANALYSIS OF ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY FOR PRIMARY VS. SECONDARY REPAIR IN 119 CONSECUTIVE CASES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011765 ANALYSIS OF ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY FOR PRIMARY VS. SECONDARY REPAIR IN 119 CONSECUTIVE CASES Ben Niver, Ilir Agalliu, Romy Bareket, Patrick Mufarij, and Michael Stifelman Ben NiverBen Niver New York, NY More articles by this author , Ilir AgalliuIlir Agalliu Bronx, NY More articles by this author , Romy BareketRomy Bareket New York, NY More articles by this author , Patrick MufarijPatrick Mufarij Winston-Salem, NC More articles by this author , and Michael StifelmanMichael Stifelman New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1804AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repair of secondary UPJ obstruction may pose additional challenges to surgeons. Robotic assistance may aid in these repairs. To evaluate this we analyzed the outcomes of our robotic-assisted primary pyeloplasty series and compared them to our series of robotic assisted secondary pyeloplasty. METHODS This study was HIPAA compliant and IRB approved. We reviewed 119 consecutive patients who underwent robotic assisted laparoscopic pyeloplasty (RALP) at our institution over an 8-year period (May 2002–February 2010). Data was collected in a combined retrospective and prospective manner. Patients were stratified into primary repair and secondary repair for primary analysis. Patients were also stratified into patients with stones and without stones for secondary analysis. We compared demographic, operative, postoperative and radiographic outcomes. Student-t test and Pearson chi-square were used for statistical analysis of continuous and categorical variables, respectively. A p-value <0.05 was considered significant. RESULTS Of the original 119 patients, data were unavailable on two patients. These patients were excluded from analysis. Ninety-seven patients underwent primary pyeloplasty repair and twenty patients underwent secondary pyleloplasty repair. Radiographic data were available for 84 patients with primary repair and 17 patients with secondary repair. Data are summarized in the accompanying tables. There were no statistical differences in patient demographic, operative, postoperative or radiographic outcomes for the primary analysis. There was a trend toward more intraoperative blood loss and more left sided repair in the secondary repair cohort. However, neither of these reached statistical significance. Additionally, there were no differences in outcomes for the secondary analysis. CONCLUSIONS This data represents the largest single center/single surgeon report of its kind with long-term follow up. This data strongly suggests that RALP is a safe and durable option for secondary pyeloplasty repair. Demographic, Operative, and Post-Operative Data Characteristic Primary Repair (n=97) Secondary Repair (n=20) p-value Mean age, years (SD) 39.4(17.4) 41.8(18.3) 0.60 Gender Males (%) 41(42) 9(45) 0.81 Females (%) 56(58) 11(55) Side Left (%) 41(42) 13(65) 0.08 Right (%) 56(58) 7(35) No. suspected crossing vessel etiology (%) 64(67.4) 16(80) 0.30 No. stones present (%) 11(11.3) 2(10) 0.86 Operative Time, minutes (SD) 218.7(55.3)⁎ 217.9(52.5)⁎ 0.95 Estimated Blood Loss, mL (SD) 62.8(77.2) 98.8(74.5) 0.06 Intra-Operative conversion rate 0 0 1.00 Length of Stay, days (SD) 2.5 2.8 0.47 Complications Minor 7(7.2) 1(5) 0.60 Major 4(4.1) 1(5) 0.85 No. need for secondary procedures (%) 3(3.1) 1(5) 0.78 Follow up, months (SD) 21.9(21.6) 26(17.4) 0.37 ⁎ In the primary cohort, OR time was unavailable for thirty-three patients. In the secondary cohort, OR time was unavailable for one patient. Radiographic Outcomes Characteristic Primary Repair (n=84) Secondary Repair (n=17) p-value No. pre-op radiographically obstructed (%) 76(90.4) 17(100) 0.18 No. post-op radiographically obstructed (%) 3(3.5) 1(5.9) 0.65 No. radiographic resolution of obstruction (%) 73 (96.0) 16(94.1) 0.72 © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e307-e308 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ben Niver New York, NY More articles by this author Ilir Agalliu Bronx, NY More articles by this author Romy Bareket New York, NY More articles by this author Patrick Mufarij Winston-Salem, NC More articles by this author Michael Stifelman New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...