Pediatric Urologic Surgery Research Articles

Indocyanine green (ICG) assessment of ureteral perfusion during pediatric robotic surgery

Vascular preservation is a tenet of successful ureteral reconstruction. Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) provides real-time identification of tissue perfusion during robotic surgery. Here, we present our utilization of NIRF with ICG to ensure adequate ureteral perfusion during robotic reconstruction in 3 pediatric patients. Between July 2019 and May 2020, we utilized NIRF with ICG during 3 consecutive robotic ureteral reconstructive cases in an academic pediatric urology practice. Patients were 3-, 14-, and 17-years-old and presented with congenital ureteral stricture, mid-ureteral polyp disease, and distal-ureteral polyp disease, respectively. Following surgical reconstruction of each patient's underlying pathology, ICG doses of 0.039–0.086 mg/kg IV were used to elucidate blood supply to the affected segment of ureter prior to closing. In all 3 cases, NIRF with da Vinci Xi endoscope's Firefly® technology confirmed perfusion proximal and distal to target anatomy within 60 seconds of administration. Use of ICG appears to be low-cost, safe, and useful during pediatric urologic robotic surgery. This technology may be helpful to confirm satisfactory blood supply to the ureter following robotic ureteral reconstruction, as demonstrated in our case series of 3 pediatric patients.

SC124 - Hidden incision endoscopic surgery (HIDES) in pediatric urology: initial experience in a single center

SC124 - Hidden incision endoscopic surgery (HIDES) in pediatric urology: initial experience in a single center

Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction.

For ureteropelvic junction obstruction (UPJO), the standard of surgical care is dismembered pyeloplasty. This applies both for intrinsic but also for extrinsic etiology of the UPJO. When in 1995, Peters described for the first time laparoscopic pyeloplasty in children, the era of laparoscopic pediatric urological surgery began. Nowadays, laparoscopic dismembered pyeloplasty in children has evolved to become the gold standard. In this article, we report a standardized technique of laparoscopic transperitoneal dismembered pyeloplasty for infants and children. The described single steps of the procedure are reproducible regardless of age and weight and thus offer a high surgical success rate.

PD60-06 OMISSION OF AMBULATORY NARCOTICS IS SAFE AFTER THE MAJORITY OF INPATIENT PEDIATRIC UROLOGIC SURGERIES

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making V (PD60)1 Sep 2021PD60-06 OMISSION OF AMBULATORY NARCOTICS IS SAFE AFTER THE MAJORITY OF INPATIENT PEDIATRIC UROLOGIC SURGERIES Jeffrey Villanueva, Benjamin Pifer, Marc Colaco, Valentina Grajales, Omar Ayyash, Rajeev Chaudhry, Francis Schneck, Glenn Cannon, and Janelle Fox Jeffrey VillanuevaJeffrey Villanueva More articles by this author , Benjamin PiferBenjamin Pifer More articles by this author , Marc ColacoMarc Colaco More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Omar AyyashOmar Ayyash More articles by this author , Rajeev ChaudhryRajeev Chaudhry More articles by this author , Francis SchneckFrancis Schneck More articles by this author , Glenn CannonGlenn Cannon More articles by this author , and Janelle FoxJanelle Fox More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002097.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Opiate overdose has reached epidemic levels in the United States, and as such several states have implemented various strategies to curb usage. In November 2016 Pennsylvania passed Act 125 requiring written consent when prescribing opiates to a minor and limiting opiate prescriptions to a seven day course. The purpose of this study is to examine the effect of this state mandate on narcotic utilization and pain related outcomes after inpatient pediatric urologic surgeries. METHODS: A retrospective analysis was performed examining all patients who underwent inpatient pediatric urologic surgery at the Children’s Hospital of Pittsburgh between August 2015 and February 2020. Subjects were separated into pre-mandate and post-mandate cohorts (subtracting a 6 month window immediately after November 2016 to account for transition). We then assed the frequency of inpatient and ambulatory opiate utilization between cohorts as well as the use of alternative pain management approaches. Frequencies of adverse events including delayed prescriptions or emergency department visits within 30 days were also identified. RESULTS: After accounting for a 6-month transition period following policy implementation, 462 major pediatric urologic procedures were identified. The frequency of discharge opiate prescriptions decreased from 68.4% prior to the transition period to 10.7% afterward (p <0.001). Morphine milligram equivalents per prescription decreased from 75(IQR 45-150) to 45(IQR 22.5-75) (p <0.001). There was no change in the rate of delayed non-opioid analgesic prescriptions (6.6 % vs 7.4%), delayed opioid prescriptions (1.5% vs 0.3%), or emergency department visits (11.8% vs 12.6%) (p=0.809). The effect of the intervention was durable, where 1.7% of major pediatric urologic surgeries in the final 12 months of the study were discharged with an opioid. CONCLUSIONS: Omission of ambulatory narcotics is safe for most major pediatric urologic surgeries and does not require an increase in regional anesthesia utilization. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1062-e1062 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Villanueva More articles by this author Benjamin Pifer More articles by this author Marc Colaco More articles by this author Valentina Grajales More articles by this author Omar Ayyash More articles by this author Rajeev Chaudhry More articles by this author Francis Schneck More articles by this author Glenn Cannon More articles by this author Janelle Fox More articles by this author Expand All Advertisement Loading ...

MP34-13 A PROSPECTIVE ANALYSIS OF OPIOID USE FOLLOWING OUTPATIENT PEDIATRIC UROLOGIC SURGERY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-13 A PROSPECTIVE ANALYSIS OF OPIOID USE FOLLOWING OUTPATIENT PEDIATRIC UROLOGIC SURGERY Rachael Sherrer, Ann Byrne, Fardod O'Kelly, Ruthie Su, and Walid Farhat Rachael SherrerRachael Sherrer More articles by this author , Ann ByrneAnn Byrne More articles by this author , Fardod O'KellyFardod O'Kelly More articles by this author , Ruthie SuRuthie Su More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While opioids have a role in multimodal post-operative analgesia, there is increasing data which suggests they may not be routinely required after pediatric surgery. With this lack of consensus on opioid use after pediatric urologic procedures, we sought to examine impact of patient characteristics and surgery type on opioid usage in our outpatient urologic surgery cohort. METHODS: This prospective study was approved by the hospital’s Institutional Review Board. Opioid use data was prospectively collected over a 12-month period (January to December 2020) via routine institutional post-operative telephone calls to parents of patients undergoing outpatient urologic surgery. Patient characteristics (age, sex, race), surgery type, and opioid prescription and refill information were recorded. Those who underwent a simultaneous procedure with another specialty or were admitted to the hospital were excluded. All patients were prescribed scheduled acetaminophen and ibuprofen for 48 hours after surgery, then as needed, and up to a maximum of 5 doses of oxycodone. The count of opioid doses was modelled using negative binomial regression with robust standard errors. RESULTS: 263 patients underwent outpatient urologic surgery over the 12-month period. 182 predominantly male (99%) patients met inclusion criteria, with mean age of 5.1 years and mean 4.9 opioid doses prescribed per patient. There were 138 genital, 21 inguinal, 17 laparoscopic, and 6 cystoscopic procedures. Mean opioid use was one single dose, and 94 (52%) patients used no opioids. The mean number of excess, unused prescribed doses per patient was 4. Eleven patients used all doses prescribed, and one received a refill (5 additional doses). Table 1 outlines opioid use by surgery, age, and race. These were not independent predictors of opioid use on multivariable analysis, although there was a trend toward increased use in adolescents. CONCLUSIONS: Our findings suggest that opioids are in fact likely over-prescribed after outpatient pediatric urologic surgery, with 93% of patients not requiring all of their opioid prescription and 52% not using any opioids at all. While overall opioid requirements were low across all sub-cohorts, there was a trend toward increased use in adolescents which should be factored into education with this group. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e621-e621 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachael Sherrer More articles by this author Ann Byrne More articles by this author Fardod O'Kelly More articles by this author Ruthie Su More articles by this author Walid Farhat More articles by this author Expand All Advertisement Loading ...

Pediatric Urologic Surgery: Reducing Opioid Use.

Adequate pain management is important for successful postoperative recovery after any surgical procedure. Unfortunately, the USA and many other parts of the world are in the midst of an opioid epidemic, and healthcare providers are thus tasked with balancing the comfort and recovery of their patients after an operation against the individual and societal harms of the over-prescription of opioids. The goal of this article is to discuss the range of opioid formulations currently in use, examine why this may be problematic, and explore alternatives that provide similar efficacy and may improve overall safety in the pediatric population after urologic surgery. Improving the way opioids are prescribed through clinical practice guidelines as well as considering alternatives to opioids can ensure patients have access to safer and more effective pain treatments and potentially reduce opioid misuse.

Robotics and future technical developments in pediatric urology

Minimally invasive surgery (MIS) has represented the main innovation in the field of pediatric surgery and urology over the last 30 years. Pediatric MIS is a wide field, ranging from the standard laparoscopic surgery using 3-mm ports to robotics mainly adopted for pediatric urology indications. The aim of this paper was to summarize the current status of robotic surgery in pediatric urology and to evaluate possible future technical developments for this technique. In pediatric urology, many procedures are challenged by the narrow working space available in smaller children, the difficulty to perform complex and long suture lines to repair complex urinary malformations, and the challenge to remove renal or adrenal tumors. The main characteristic of robotic surgery is that the robotic instruments inserted into the abdominal cavity are remotely controlled by the surgeon, who is sitting at a console next to the patient or even far away, avoiding human tremor during complex suturing. Due to the magnification of the operative field view and the six degrees of freedom of the robotic instruments compared to conventional laparoscopic instruments, providing enhanced 3D vision and improved surgeon ergonomics, robot-assisted surgery appears to be beneficial over conventional MIS, especially in complex reconstructive procedures. Currently, there are two robotic systems available on the market and certified for robotic surgery in children: the DaVinci (Intuitive Surgical, since 2001) and Senhance (Transenterix, since 2020). However, almost the totality of papers published in the international literature are focused on robotic procedures using the DaVinci platform. Analyzing the current literature, there is no evidence about the indications where robotics are preferable to conventional MIS approaches. Currently, the main indications of robotic surgery in pediatric urology are: pyeloplasty for ureteropelvic junction obstruction (UPJO), ureteral reimplantation according to Lich Gregoire technique, Mitrofanoff procedure, nephrectomy or partial nephrectomy for oncological indications, removal of renal cysts, bladder neck reconstruction or removal of urinary tract stones. The future developments in this field are certainly represented by intraoperative use of indocyanine green (ICG) fluorescence imaging that permits to have a better vision of vascular anatomy or clearly identify nodes in case of tumors, and by development of 5G technology. The main limitation of robotic surgery today remains the excessive cost of the machine itself and the limited lifespan of robotic instruments. We believe that robotic surgery will surely represent the new field of development in pediatric surgery, but its widespread application will depend on the introduction of new robotic platforms in the market, that will certainly low the costs, and also to the development of smaller size instruments more suitable for pediatric use.

Development of ureteroneocystostomy in pediatric population: ten years of experience from Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia

Background: Ureteroneocystostomy is one of the most common surgery in pediatric urology. The procedure can be performed either laparoscopically or in open surgery fashion. Currently, there is limited data available regarding the outcome of pediatric ureteroneocystostomy in Indonesia. The aim of this study is to evaluate the efficacy and safety of pediatric ureteroneocystostomy in both laparoscopic and open surgery techniques in one of the largest referral hospitals in Indonesia.Methods: This is a retrospective study in which all patients with age of 18 or below underwent ureteroneocystostomy in Cipto Mangunkusumo general hospital was included in ten years period. The outcome analyzed was the patients' demographic profile, procedure duration, blood loss, and length of stay of the patients.Results: A total of 46 patients underwent ureteroneocystostomy from year 2010 to 2020 with 38 patients underwent open surgery and 8 patients underwent laparoscopic surgery. The median age of the patients was 5 years old, which predominantly female (60.9%). The most common urology condition was vesicoureteral reflux and ectopic ureter at 34.8%. The median procedure duration was significantly shorter in the open surgery than laparoscopic group (180 and 325 minutes, respectively; p=0.002). There was no significant difference in blood loss and length of stay between two groups.Conclusion: The preferred ureteroneocystostomy technique used was open surgery, with the most common etiology of the patients underwent the procedures were vesicoureteral reflux and ectopic ureter. In addition, the open surgery approach also leads to a shorter procedure duration than laparoscopy.

Opioid Use after Pediatric Urologic Surgery: Is It Really Needed?

ObjectivesTo identify factors associated with opioid use after pediatric urologic surgery, use this data to educate our patients and colleagues on decreasing post-operative opioid use, and assess the effectiveness of this approach. MethodsFrom 1/2018 - 12/2019, a written questionnaire asking which pain medications were used after surgery was given to patients’ families before routine post-operative appointments. A retrospective review of the surveys and patient charts was performed. Demographic factors were compared between patients who did and did not use opioids with Fisher's exact and t tests. Midway through the study, the results were presented to the urology department in an attempt to reduce opioid use over the next year. The number of opioid prescriptions and patients who used opioids after surgery in 2018 versus 2019 was compared. Results1001 patients were included with a mean age of 5 years, 96% male. Patients used a mean of 4.5 doses of opioids and 83% had leftover opioids. Factors significantly associated with not using opioids included age less than 3, penile, and endoscopic surgery. Between 2018 and 2019–despite no significant difference in patient age, gender, or procedure type–the number of patients who were prescribed (61% vs 34%, P < .0001) and who used opioids (55 vs 28%, P < .0001) was significantly decreased. ConclusionAfter pediatric urologic surgery, many patients do not need opioid prescriptions. Reviewing our own opioid use practices and providing education within our department allowed us to significantly decrease the number of opioids prescribed and used after surgery.

Türkiye’de doğum hızının en yüksek olduğu Şanlıurfa ilinde Covid-19 pandemisinin pediatrik üroloji operasyonları üzerindeki etkisinin araştırılması

Investigation of the effect of Covid-19 pandemic on pediatric urology operations in Şanliurfa province, where the birth rate is the highest in Turkey Abstract: Objective: The aim of this study is to investigate the effect of the COVID-19 pandemic on pediatric urology operations. Materials and Methods: Hospital records of pediatric patients who applied to Harran University Medical Faculty Pediatric Urology Clinic during the pandemic period (19 March-22 December 2020) and pre-pandemic period (19 March-22 December 2019) and were operated with precautions were retrospectively analyzed. The number of outpatient clinic patients during and before the pandemic period, the number of operations and indications, and the types of surgery were compared. The names and numbers of surgical procedures are listed according to the European Association of Urology (EAU) priority classification. Results: During the COVID-19 pandemic period, the number of pediatric patients admitted to the outpatient clinic was 2361, while it was 5214 in the same period before the pandemic. It was observed that the number of patients who applied to the outpatient clinic decreased by 54.8% during the pandemic period. While the total number of pediatric operations was 316 during the pandemic period, it was 741 before the pandemic period. When the pandemic period was compared with the pre-pandemic period, a 58.4% reduction was observed in pediatric urology operations. The number of emergency operations was 69 during the pandemic period and 85 in the pre-pandemic period. During the pandemic period, the reduction in emergency operations was 18.8%. No complications were observed due to COVID-19 in any of the operated patients. Conclusion: During the COVID-19 epidemic, it was observed that the number of pediatric urology outpatient clinic admissions and surgeries in our hospital decreased. In cases where urgent interventions were required, adequate precautions were taken, and surgical operations could be applied without any contamination and mortality. Keywords: Coronavirus, coronavirus disease 2019, pandemic hospital, pediatric urological surgery.

Pediatric Robotic Adrenalectomy for Virilizing Adrenal Tumor in a 4-year-old Female

Adrenocortical tumors in children are rare, with approximately 90% of children presenting with endocrine syndromes, most commonly virilization. The standard treatment remains an open resection, although there is increasing use of the minimally invasive approach. With the advent of robotic surgery, its advantages over open and conventional laparoscopy make it a viable option in select patients. Despite the adoption of robot-assisted surgery in pediatric urology, limited literature regarding robotic pediatric adrenal surgery exists, with only a few small case series. We present a female child with virilizing features due to a large functional adrenal tumor managed by robot-assisted adrenalectomy.

Adherence and Acceptability of an Oral Antibiotic Used for the Prevention of Pediatric Urinary Tract Infection in Japan.

Urinary tract infection (UTI) is a common health care-associated adverse event and the leading nosocomial complication following pediatric urological surgery. While continuous antimicrobial prophylaxis effectively reduces the risk of UTI following such a surgery, non-adherence is common and represents a distinct clinical entity that is associated with renal scarring. Acceptability is likely to have a significant impact on patient adherence. Herein we used a validated data-driven approach—the ClinSearch acceptability score test (CAST)—to investigate the acceptability of cefaclor, an oral antibiotic widely used for the prevention of pediatric UTI in Japan. Standardized observer reports were collected for 58 intakes of cefaclor 10% fine granules in patients aged from 0 to 17 years. The medicine was classified as positively accepted on the acceptability reference framework. According to the percentage of the prescribed dose taken reported at the end of the treatment, patients exhibited good adherence to this well-accepted medicine. Nonetheless, requirements for greater dosing frequency or poor acceptability in certain patients could affect adherence. Acceptability should be established to ensure patient adherence to medicines used for long-term prophylaxis and consequently guarantee the safety and efficacy of the treatment.

Minimal invasive surgery in pediatric urology

Minimal invasive surgery in pediatric urology

Is Ultrasound-Guided Single-Shot Quadratus Lumborum Block a Viable Alternative to a Caudal Block in Pediatric Urological Surgery?

To review our experience with quadratus lumborum block (QLB) in pediatric urology. This mixed prospective-retrospective study included 41 patients who received QLB following induction of general anesthesia. Data collected included: the duration of block induction, surgery, hospitalization, postoperative pain score, and the use of rescue analgesia. The results were compared with a matched cohort of patients who received caudal block (CB) during similar surgeries from our retrospectively acquired data registry. There was no difference between the type and length of surgery, weight, sex, and age of the patients between the two groups. The duration of block induction was significantly shorter in the CB group compared with the QLB group (35.6 ± 14.6 vs. 239 ± 33.4 seconds [p < 0.0001]). There was no difference between the groups in pain scores at 1, 4, and 24 hours postoperatively, in the time to first rescue analgesia, or in the postoperative opioid requirements. However, the QLB group required more rescue analgesia compared with CB group (p = 0.016). Finally, no differences were found in the use of rescue analgesics at home, pain record behavior, and overall satisfaction. Our data show that QLB might serve as a viable alternative to CB in pediatric urological surgery.

Opioid prescribing is excessive and variable after pediatric ambulatory urologic surgery

Acute pain after surgery is one of the most frequent indications for opioid prescribing in children. Opioids are often not stored or disposed of safely after their use, placing children and others in the home at risk for accidental ingestion or intentional misuse. We currently lack evidence-based guidelines for post-operative pain management after common ambulatory pediatric urologic procedures. Thus, each surgeon must decide if and how much opioid to prescribe based on his/her own assumptions of perceived post-operative pain. As part of an effort to establish opioid prescribing guidelines across two academic centers, the objectives of this study were to evaluate current variability in pediatric urologists' opioid prescribing factors and identify patients at greatest risk of being prescribed high doses of opioids after common ambulatory pediatric urologic procedures. We retrospectively evaluated post-operative opioid prescribing patterns after common ambulatory pediatric urology procedures (circumcision, orchiopexy, and hernia/hydrocele) at two major children's hospitals. Specifically, we evaluated if and how much opioid was prescribed for all children (18 years or younger) between 2016 and 2017. Bivariate analysis was performed using Kruskal-Wallis Test and Wilcoxon Rank Sum. Multivariable logistic regression was performed to determine patient, surgeon, and procedural factors that predicted the prescription of a high dose of opioids (greater than the median number of doses prescribed for that procedure). Over the two-year period, 811 circumcisions and 883 inguinal surgeries (inguinal orchiopexy and hernia/hydrocele) were performed. 94% of patients undergoing circumcision and 97% of those undergoing inguinal surgery were prescribed opioid analgesia. The median number of doses prescribed for circumcision was 20; for inguinal surgeries, 23.75% of patients received 15 opioid doses or more. Patients ages 0-2 years, who represented the largest age group (41% of all patients), received significantly more opioid doses than all other age groups, followed by those >10 years (p<0.01). There was significant variation in opioid prescribing patterns by provider (p<0.01) (Figure1) On multivariable logistic regression, younger age, pill form, and earlier year were all associated with a greater number of opioid doses prescribed for all surgeries. Across two institutions without a formal post-operative opioid prescribing policy for ambulatory pediatric urologic procedures, we observed considerable variability in provider prescribing patterns, with nearly all patients receiving an opioid, and those 0-2 years receiving the highest number of doses. This highlights the need for evidence-based guidelines for post-operative pain management after ambulatory pediatric urologic surgeries.

Surveying unmet pediatric urological needs in low- and middle-income countries

Access to pediatric urological surgery is low in low-and-middle income countries (LMICs). Pediatric Urological missions have often been undertaken without best practice guidelines. Many strides have been made in pediatric general surgery and other surgery but little in pediatric urology as a component of global surgery. The purpose of this study was to identify challenges to delivery of pediatric urological care in LMICs and make recommendations for its advancement. An internet search for reports and websites was undertaken. Published surveys from Global Initiative for Children Surgery (GICS) and American Pediatric Surgical Association (APSA) were evaluated. We developed and administered an additional questionnaire. Respondents included LMIC pediatric surgeons, HIC pediatric surgeons and HIC pediatric urologists and LMIC urologists and general surgeons. Most global surgical visits were short one-time visit, and respondents citing complex pediatric urologic patients as most neglected in LMICs with the main challenge reported as a lack of specialist surgeons, poor communication between groups and poor infrastructure. Local specialist training was universally recommended as the most effective way to address unmet needs, although the form of training was not clear. Most published work has looked at global general surgery or pediatric general surgery [1][2][3][6][8][11][13] but little on pediatric urology. Most of the information provided was blog posts of social engagements but rarely did these websites provide information on the surgical experience, challenges and solutions gleaned overtime[41][43][44][45][56] It is recognised by pediatric urologists, general urologists and pediatric surgeons that complex urologic anomalies are the most neglected among children's surgical conditions with a higher disability weight attributed to urologic conditions compared to anorectal conditions. [6][8][14][27][31][36][46], yet there's little expertise on ground and many challenges to its advancement. This study was limited by the number of questions we could explore due to the need to make questions fewer and more concise. Pediatric urological conditions remain among the most neglected in global surgery. Current missions face significant challenges that may result in suboptimal outcomes. A comprehensive effort to establish guidelines for these missions is imperative.

Enhanced recovery after surgery and anesthetic outcomes in pediatric reconstructive urologic surgery.

Enhanced recovery after surgery (ERAS) is a perioperative management strategy to hasten postoperative recovery. We examined the effects of a pilot implementation of ERAS for pediatric patients on anesthetic outcomes. We performed a prospective case-control study utilizing an ERAS protocol in patients aged < 18years undergoing urologic reconstruction that included a bowel anastomosis. Protocol elements included: multimodal analgesia, opioid minimization, and routine nausea/vomiting prophylaxis. ERAS patients were propensity-matched with historical controls. Outcomes of interest included maximum PACU pain score, time to first opioid, opioid-free days, and need for opioids on day of discharge. A total of 13 ERAS patients and 26 historical controls were included, with median ages 9.9years (IQR 9.1-11) and 10.4years (IQR 8.0-12.4), respectively. ERAS increased the percentage of patients who did not receive any intraoperative or postoperative opioids (0% vs 15%, p = 0.046 for both) and reduced maximum PACU pain score (3 vs 0, p < 0.001). The use of postoperative supplemental oxygen was decreased in the ERAS group (85% vs 38%, p = 0.013). The implementation of an ERAS protocol appears to decrease postoperative pain, opioid usage, and positively impact other anesthetic outcomes in children undergoing urologic reconstructive surgery utilizing a bowel anastomosis.

Do post-operative phone calls enhance family satisfaction and outcomes after outpatient pediatric urological surgeries? A prospective study.

This study assesses whether post-operative check-in phone calls (POPC) performed within 48h of outpatient pediatric urological surgeries by a non-medical professional (NMP) would increase patient/family satisfaction and minimize extraneous resource use by increasing email/telephone communication, while reducing emergency department (ED) visits within 30days of that procedure. Families of patients undergoing ambulatory pediatric urology surgeries were enrolled over 8weeks. Group 1 did not receive POPC. Group 2 received a POPC within 48h of their operation by a NMP. Both groups received a phone-call survey 2weeks after surgery to assess families' perioperative satisfaction. In total, 74 families were enrolled (Group 1 = 44, Group 2 = 31). The response rates to phone surveys for Groups 1 and 2 were 59.1% and 77.4%, respectively. POPC did not improve perioperative satisfaction, nor did it significantly promote the use of nursing email/telephone communication (19.2% vs. 4.2%, p = 0.128) or reduce ED visits (15.4% vs. 0.0%, p = 0.111). However, all families in Group 2 thought POPC was timed appropriately and 79.1% perceived it to be helpful in reducing post-operative anxiety. POPC by a NMP within 48h of surgery may not affect perioperative satisfaction of families of patients undergoing same-day pediatric urology surgery but may have an impact in reducing post-operative anxiety.

Trends in robotic surgery utilization across tertiary children's hospitals in the United States.

A growing number of tertiary children's hospitals are utilizing robotic surgical technology. We sought to characterize national trends in pediatric surgical robotic case utilization and related drivers. Pediatric urology and pediatric surgery (abdominal and thoracic) procedures, performed from January 2010 to December 2019 across 19 U.S. tertiary care children's hospitals, were identified using the Pediatric Health Information System (PHIS). Trends in robot utilization were evaluated by surgical subspecialty, procedure type, and number of individual operating surgeons. Increases were noted in the overall numbers of pediatric surgery (1.3% per quarter, p = 0.005) and urology robotic procedures (2.0% per quarter, p < 0.001), as well as the numbers of pediatric surgeons (7.5% per year, p < 0.001) and pediatric urologists (7.8% per year, p < 0.001) operating robotically. Biliary system and spleen surgery were the most common robotic pediatric surgery procedures (45.5%) and had stable utilization over time (- 0.8% per quarter, 95% CI - 2.3-0.8). Robotic foregut surgery showed the most rapid growth in utilization (2.1% per quarter, 95% CI 0.7-3.6, p = 0.004) in pediatric surgery, while mediastinal/thoracic surgery demonstrated a decrease in utilization (- 4.6%, 95% CI - 7.9-1.2, p = 0.008). Renal pelvis/ureter surgery was the most common robotic urologic procedure (55.8%) and also demonstrated the fastest growth utilization (2.2% per quarter, 95% CI 1.5-2.9, p < 0.001) in urology. Utilization of robotic-assisted surgery in pediatric surgery and pediatric urology has increased both in case volume and the number of operating surgeons, with foregut and renal pelvis/ureter surgery responsible for the areas of greatest growth.

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...