Invasive Surgery In Pediatric Urology Research Articles

Pediatric robotic urologic procedures: Indications and outcomes.

Robotic-assisted laparoscopic surgery (RALS) has revolutionized minimally invasive surgery in pediatric urology. The robotic platform allows surgeons to maintain the benefits of laparoscopic surgery while having enhanced three-dimensional view, dexterity, range of motion, and control of high-resolution cameras. In this review, we summarize the indications and recent outcomes for various pediatric urologic RALS procedures to illustrate the current state of robotics in pediatric urology. We systematically searched the PubMed and EMBASE databases. We extrapolated and summarized recent evidence on RALS in pediatric urology patients, with an emphasis on indications and outcomes, with regard to the following procedures and search terms: pyeloplasty, kidney stone surgery, partial nephrectomy, nephroureterectomy, ureteral reimplantation, appendico-vesicostomy, augmentation cystoplasty, bladder neck reconstruction, and Malone antegrade continence enema. Additional Medical Subject Headings terms used to augment the search included "Treatment Outcome" and "Robotic Surgical Procedures." Increasing usage of RALS has shown many benefits in perioperative and postoperative outcomes. In addition, there is growing evidence that robotic procedures in pediatric urology result in similar or better surgical outcomes when compared to the standard of care. RALS has shown considerable effectiveness in pediatric urologic procedures and may achieve surgical outcomes comparable to the standard approaches of open or laparoscopic surgery. However, larger case series and prospective randomized controlled trials are still necessary to validate the reported outcomes, in addition to cost analyses and studies on the surgical learning curve. We believe that the continuous evolution of robotic platforms will allow for enhanced care and quality of life for pediatric urology patients.

Minimal invasive surgery in pediatric urology

Minimal invasive surgery in pediatric urology

Developing Simulation Models for Minimally Invasive Surgery in Pediatric Urology

Introduction: Minimally invasive urologic surgery has a challenging learning curve. The development of a simulation surgical training program has become an essential tool in the pediatric urology f...

Surgical Scar Location Preference for Pediatric Kidney and Pelvic Surgery: A Crowdsourced Survey

The benefits of minimally invasive surgery in pediatric urology, such as reduced length of hospital stay and postoperative pain, are less predictable compared to findings in the adult literature. We evaluated the choices that adult patients make for themselves and their children regarding scar location. We surveyed the preference for scar location/size based on surgery for bladder and kidney procedures with additional questions assessing the impact of a hidden incision, length of hospital stay and pain. The survey was posted to Amazon® Mechanical Turk®. We analyzed a total of 954 completed surveys. Surgical history was reported in 660 surveys (69%) with scar bother reported in 357 (54.2%). For pelvic surgery the initial choice was a Pfannenstiel incision for 434 respondents (45.5%), laparoscopy port incisions for 392 (41.1%) and no preference for incision location for 126 (13.2%). When incisions were illustrated relative to undergarments, 718 respondents (75.3%) chose Pfannenstiel. For kidney surgery 567 respondents (59.4%) initially chose the dorsal lumbotomy incision, 170 (17.8%) chose a flank incision, 105 (11.0%) chose laparoscopy ports and 110 (11.5%) had no preference. Respondents were told that minimally invasive surgery might result in less pain/length of hospital stay and were asked to restate the incision choice. For pelvic surgery 232 of 434 respondents (53.5%) who had chosen Pfannenstiel and 282 of 394 (71.6%) who had chosen laparoscopy remained consistent (p <0.001). For kidney surgery 96 respondents (56.5%) who chose a flank incision, 322 (56.8%) who chose dorsal lumbotomy and 68 (64.2%) who chose laparoscopy remained consistent (p = 0.349). Agreement between the incision choice by respondent as a child and for a child was 82% (κ = 0.69) for pelvic surgery and 84.6% (κ = 0.75) for kidney surgery. The smallest incision is not always the patient preferred incision, particularly in childhood when pain, length of hospital stay and blood loss may be equivocal among approaches. Discussion of surgical treatment options should include scar length, location and relationship to undergarments.

Pediatric Laparoscopic Congenital Vesico-Vaginal Fistula Repair for Vaginal Agenesis

Abstract Introduction: The role of minimally invasive surgery in pediatric urology has markedly expanded, but has not been traditionally applied to vesico-vaginal fistulae repairs in children. The ...

Minimally Invasive Surgery in Infants: Con

No AccessJournal of UrologyOpposing View1 Nov 2012Minimally Invasive Surgery in Infants: Con Martin A. Koyle Martin A. KoyleMartin A. Koyle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.08.048AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Minimally Invasive Surgery in Infants: Con." The Journal of Urology, 188(5), pp. 1664–1665 References 1 : The new surgery. Br Med J (Clin Red Ed)1987; 295: 1581. Google Scholar 2 : Laparoscopic nephrectomy in the first year of life. J Pediatr Surg1993; 28: 693. Google Scholar 3 : “Open” minimally invasive surgery in pediatric urology. J Pediatr Urol2009; 5: 221. Google Scholar 4 : Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single site (LESS), laparoscopic, and open surgery. BJU Int2012; 110: 268. Google Scholar 5 : The Innovator's Prescription. New York: McGraw Hill2009. Google Scholar Department of Surgery, University of Toronto, Pediatric Urology, Hospital For Sick Children, Toronto, Ontario, Canada© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 188Issue 5November 2012Page: 1664-1665 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin A. Koyle More articles by this author Expand All Advertisement PDF downloadLoading ...

Minimal invasive surgery in pediatric urology

Minimal invasive surgery in pediatric urology

Commentary to “‘Open’ minimally invasive surgery in pediatric urology”

I read with interest the article entitled ‘Open’ minimally invasive surgery in pediatric urology. The authors report and discuss their experience with, what they call, open minimally invasive surgery (MIS). Open MIS is defined as a surgical technique which uses small incisions and obviates the use of laparoscopic instruments. It is true that the term ‘minimally invasive surgery’ was, by tradition, understood to refer to laparoscopic or endoscopic surgery. This was probably already a lexical shortcut since, though the incisions might individually be smaller, the surgery itself is often not less invasive. The problem with new terms such as ‘open minimally invasive surgery’ is that these appellations are purely arbitrary, they relate solely to incision size, and in some cases the surgery itself seems more invasive than classic surgery. In this report, the authors refer to open MIS for renal surgery performed through small incisions (ranging from 1.3 to 2.5 cm in patients 10 years of age). What is the definition of small? Is it defined just as smaller than we used to perform? Or smaller than other surgeons do? Most of us try to use small incisions, but when do they become minimally

“Open” minimally invasive surgery in pediatric urology

Minimally invasive surgery (MIS) offers alternative operative approaches to standard open surgical techniques. However, MIS has been defined primarily as substituting laparoendoscopic alternatives for the traditional open surgical approach. The concept of MIS methodology may also be applied to open surgery in an effort to decrease incision size, potentially reduce morbidity and enhance convalescence, without compromising 'gold standard' outcomes. Pediatric urological applications of open MIS include pediatric renal surgery, ureteral reimplantation, ureteral surgery, inguinal-scrotal and genital surgery. A thorough review of the pediatric urology literature was performed and studies were identified describing open MIS, including outcomes and complications.

A CLINICAL SERIES OF LAPAROSCOPIC NEPHRECTOMY, NEPHROURETERECTOMY AND HEMINEPHROURETERECTOMY IN THE PEDIATRIC POPULATION

Laparoscopic techniques have enabled less invasive surgery in pediatric urology. We report our experience with laparoscopic nephrectomy, nephroureterectomy and heminephroureterectomy in 26 children, and evaluate our series to establish the safety and efficacy of such procedures for benign disease. Laparoscopic procedures were done in 15 girls and 11 boys 4 months to 11 years old (mean age 37) during a 23-month period. Laparascopic surgery consisted of nephrectomy in 14 (1 horseshoe kidney), nephroureterectomy in 6 and laparoscopic heminephroureterectomy in 6 cases. Mean overall operative time for the laparoscopic procedures was 165 minutes (range 43 to 355). Blood loss was less than 5 cc in all cases and there were no intraoperative complications in our series. Overall postoperative analgesic administration during hospitalization was 0.20 mg./kg. morphine sulfate and 19 mg./kg. acetaminophen as well as 0.9 mg./kg. codeine in 6 patients who did not receive morphine. Three children were discharged home on the day of surgery, while 17, 3, 1 and 2 were discharged home on postoperative days 1, 2, 4 and 5, respectively. Cosmetic results were excellent in all cases. Nephrectomy, nephroureterectomy and heminephroureterectomy may be performed for benign disease in children using laparoscopy with minimal morbidity, minimal postoperative discomfort, improved cosmesis and a short hospital stay. It may even be done as an outpatient procedure.