Laparoscopic and Robot-assisted Laparoscopic Reimplantation for Lower Ureter Pathology. A Multi-institutional Comparative Study in 1343 Patients

Abstract

ObjectiveTo evaluate the outcomes of children with vesicoureteral reflux (VUR) and obstructive megaureter (OM) utilizing various laparoscopic and robot assisted approaches. Materials and methodsRetrospective review of all pediatric laparoscopic and robot assisted cases for lower ureter pathology was performed between 2016-2022 in 13 academic centers worldwide. Five surgical approaches were assessed: LEUR,LVCUR,LDECUR,RALUR and RADECUR. Results1343 patients (490 boys and 853 girls) with a median age of 30 month (IQR 12-63) were treated at 13 centers. 908 patients (68%) underwent reimplantation due to VUR (unilateral in 818 and bilateral in 90 patients). 435 (32%) had a surgery due to UVJ obstruction. Mean length of follow up was 14 month (IQR 8-33). Median operative time was 202 minutes (IQR 142-220) in the robotic arm compared to 240 minutes (IQR 160-267) in the laparoscopic (p=0.45). Intracorporeal excisional tapering was performed in 118 (8%) of the patients. 6 patients in the OM group required additional surgery due to progressive obstruction. In the VUR group, 84% underwent VCUG postoperatively. 5.6% showed residual reflux. Grade 1-2 Clavien-Dindo complications occurred in 10 patients (0.7%) and 6 (0.4%) in the laparoscopic and robotic arm respectively. Grade 3 complication occurred in 17 (1.2% and 8 (0.5%) in both arms respectively. Surgical success was achieved in 96% of patients. ConclusionLaparoscopic and robot assisted laparoscopic approaches are simple, safe, and effective for treating all grades of VUR and OM. Robot assisted approach is beneficial in terms of operative time, intracorporeal suturing and lower complications rate.