Robot-assisted Laparoscopic Pyeloplasty Research Articles

Single-port robot-assisted laparoscopic pyeloplasty in an infant: A video case report with 9 months follow up

Single-port robot-assisted laparoscopic surgery is a breakthrough in the field of minimally invasive surgery. However, it is currently only applicable to older children due to the limitation of operating space. Here, we report a case of single-port robot-assisted laparoscopicpyeloplasty (RALP) using the da Vinci Xi® surgical system in a 7-months infant. A 7-month-old infant with ureteropelvic junction obstruction (UPJO) underwent single-port RALP conducted using the da Vinci Xi® System. Retrospective perioperative, immediate postoperative outcomes and 9 months follow up were investigated. Surgery progressed smoothly without additional operative port placement or open procedure. The total operative time was 160min, including 90min of console time. And estimated blood loss was 5ml. No intraoperative and postoperative complications were found. Postoperative follow-up showed good efficacy, and the incision seemed to be traceless. Single-port RALP using da Vinci Xi® System in infants is feasible and safe. It showed excellent efficacy in treating UPJO as shown in the short-term follow-up. Subsequent cohorts with more infant patients and long-term follow-up will be required to further validation.

Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty

PurposeThis multi-institutional study aimed to assess the outcomes of laparoscopic ureterocalicostomy (LUC) and robot-assisted laparoscopic ureterocalicostomy (RALUC) and compare them with laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO).MethodsThe data of 130 patients (80 boys), with median age 7.6 years and median weight 33.8 kg, receiving minimally invasive treatment of PUJO over a 6-year period, were retrospectively analyzed. Patients were grouped according to the operative approach: G1 included 15 patients, receiving LUC (n = 9) and RALUC (n = 6), and G2 included 115 patients, receiving LP (n = 30) and RALP (n = 85). Patient characteristics and operative outcomes were compared in both groups.ResultsThe median patient age and weight were significantly higher in G1 than in G2 [p = 0.001]. The median operative time was similar in both groups (157.6 vs 150.1 min) [p = 0.66] whereas the median anastomotic time was shorter in G1 than in G2 (59.5 vs 83.1 min) [p = 0.03]. The surgical success rate was similar in both groups (100% vs 97.4%) [p = 0.33]. Post-operative complications rate was higher in G1 than in G2 (20% vs 6.1%) but all G1 complications were Clavien 2 and did not require re-intervention.ConclusionLUC/RALUC can be considered safe and effective alternative approaches to LP/RALP for PUJO repair and reported excellent outcomes as primary and salvage procedures. Robot-assisted technique was the preferred option to treat most patients with recurrent PUJO in both groups.

Assistant port is unnecessary for robotic-assisted laparoscopic pyeloplasty in children: a comparative cohort study.

To compare the postoperative outcomes including the cosmetic results of robotic-assisted laparoscopic pyeloplasty (RALP) performed with and without assistant port in pediatric population. 47 patients with ureteropelvic junction obstruction consecutively underwent RALPwere stratified as: three-port (Group 1, n = 26) and four-port (Group 2, n = 21). In Group 1, no assistant port was placed and double-J stent was introduced with the aid of an angiocatheter via the percutaneous route. In group 2, an assistant port was placed. The Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale(VSS), Satava, Clavien classification systems, and success rates were compared. We found similar success rates for both groups (group 1:96.2%, group 2:100%). Two groups were similar in terms of improvement in the postoperative anteroposterior diameter of the renal pelvis and parenchymal thickness. There was no difference in terms of perioperative and postoperative complication rates (group 1:19.2%, group 2:9.5%). The total PSAS was significantly lower in Group 1 (p < 0.008). No difference was observed for VSS and OSAS. Using an assistant port does not improve the success or complications of RALP, while the cosmetic outcomes are inferior to three-port RALP in children. We suggest avoiding the use of assistant port during RALP in children.

Transperitoneal Versus Retroperitoneal Robotic-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children. A Multicentre, Prospective Study

BackgroundRobotic-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among paediatric urologists. ObjectiveTo compare surgical variables and clinical outcomes, including complications and success rate, with RALP using the transperitoneal (T-RALP) and retroperitoneal (R-RALP) approaches. Design, setting, and participantsWe performed a multicentre, prospective, cohort study (NCT03274050) between November 2016 and October 2021 in three paediatric urology teaching centres (transperitoneal approach, n = 2; retroperitoneal approach, n = 1). The diagnosis of ureteropelvic junction obstruction (UPJO) was confirmed by renal ultrasound and mercaptoacetyltriglycine-3 renal scan or uro–magnetic resonance imaging with functional evaluation. The exclusion criteria were children <2 yr old, persistent UPJO after failed pyeloplasty, and horseshoe and ectopic kidney. InterventionWe performed dismembered pyeloplasty using running monofilament 6-0 absorbable suture. Outcome measurements and statistical analysisWe assessed intra- and postoperative morbidity (primary outcome) and success (secondary outcome). Data were expressed as medians and interquartile range (25th and 75th percentiles) for quantitative variables, and analysed comparatively. Results and limitationsWe operated on 106 children (T-RALP, n = 53; R-RALP, n = 53). Preoperative data were comparable between groups (median age 9.1 [6.2–11.2] yr; median weight 26.8 [21–40] kg). Set-up time (10 vs 31 min), anastomotic time (49 vs 73 min), and console time (97 vs 153 min) were significantly shorter with T-RALP than with R-RALP (p < 0.001). No intraoperative complications occurred. No conversion to open surgery was necessary. The median hospital stay was longer after T-RALP (2 d) than after R-RALP (1 d; p < 0.001). Overall, postoperative complication rates were similar. No failure had occurred at the mean follow-up of 25.4 (15.1–34.7) mo. ConclusionsIn selected children, RALP is safe and effective using either the transperitoneal or the retroperitoneal approach, with a shorter hospital stay after R-RALP. Patient summaryIn our multicentre, prospective study, we compared the results and complications of robotic-assisted laparoscopic pyeloplasty (RALP) using the transperitoneal and retroperitoneal approaches. We found that RALP is safe and effective using either approach, with a shorter hospital stay after R-RALP.

Trends in opioid and nonsteroidal anti-inflammatory (NSAID) usage in children undergoing common urinary tract reconstruction: A large, single-institutional analysis

Opioid stewardship is recognized as a critical clinical priority. We previously reported marked reductions in narcotic administration after implementation of an opioid reduction protocol for pediatric ambulatory urologic surgery. We hypothesize that a decrease in post-operative and discharge opioid administration will not increase short-term adverse events. All pediatric patients undergoing open or robot-assisted laparoscopic pyeloplasty or ureteral reimplantation between 2015 and 2019 were included. Patients' demographics, opioid and NSAID administration, urology or pain-related emergency department (ED) visits, readmissions, and reoperations within 30 days of surgery, were aggregated. 438 patients, with a median age of 3.5 years (IQR 1.5-8.3) at the time of surgery, met the inclusion criteria. Annual rates of inpatient opioid administration and prescriptions decreased significantly over the study period, while rates of intra-operative, inpatient, and prescribed NSAIDs significantly increased. There was no significant difference in the occurrence of ED visits, readmissions, or reoperations within 30 days of surgery between patients who received an opioid prescription and those who did not. Multivariate regression showed that patients who did not receive an opioid prescription at discharge were found to be at a lower risk for unplanned encounters including ED visits, readmissions, or reoperations (OR:0.5, 95%CI: 0.2-0.9, p=0.04). The present study shows the decreasing trend in inpatient opioid administration and opioid prescription after discharge, when accompanied by an increase NSAID administration, does not result in a significant change in rates of unplanned encounters and complications, similar to results from previous studies on non-urological and ambulatory urological surgeries. Non-opioid pain control after major pediatric urologic reconstruction is safe and effective. We found that a reduction in opioid administration can be associated with a reduced risk of unplanned ED visits, readmissions, or reoperations. Further investigations are required to corroborate this finding.

V08-07 ROBOTIC PYELOPLASTY OF LOWER POLE MOIETY IN A 2 MONTH OLD INFANT WITH CUTANEOUS PYELOURETERAL (CPU) STENT

You have accessJournal of UrologyCME1 May 2022V08-07 ROBOTIC PYELOPLASTY OF LOWER POLE MOIETY IN A 2 MONTH OLD INFANT WITH CUTANEOUS PYELOURETERAL (CPU) STENTis corrected byV08-07 Robotic Pyeloplasty of Lower Pole Moiety in a 2 Month Old Infant With Cutaneous Pyeloureteral (CPU) Stent. Erratum Amrita Mohanty, Clark Judge, Anastasia Gliatis, Tony Da Lomba, and Mohan Gundeti Amrita MohantyAmrita Mohanty More articles by this author , Clark JudgeClark Judge More articles by this author , Anastasia GliatisAnastasia Gliatis More articles by this author , Tony Da LombaTony Da Lomba More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002606.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted laparoscopic pyeloplasty has been demonstrated to be safe and effective in infants. Here we demonstrate the steps to a left robotic pyeloplasty of a ureteropelvic junction obstruction in the lower pole moiety in a 2 month old with a duplicated left collecting system using a CPU stent. METHODS: Prenatal detection of left hydronephrosis and postnatal imaging confirmed grade 4 left hydronephrosis. Renal scan demonstrated significant obstruction of the left kidney, preserved renal function on the left (45%), and a possible duplex system on the left. Voiding cystourethrogram showed no ureteral reflux. The patient had not had any UTIs and was on antibiotic prophylaxis. After discussion with the patient’s parents, they elected to undergo a robotic left pyeloplasty to protect the patient’s renal function. RESULTS: The patient was found to have a duplicated system on the left with a high grade stenosis of the lower pole ureteropelvic junction and a dilated lower pole renal pelvis. The procedure was able to be completed in the standard fashion after the two ureters were dissected apart. The patient recovered well and was discharged on post op day 1. CPU stent was removed on post op day 12. He did suffer a superficial infection of the umbilical surgical site that resolved with antibiotics. At 6 weeks post-op, the patient was doing well and renal ultrasound showed a decompressed, but still hydronephrotic, left kidney. CONCLUSIONS: This video demonstrates that a robotic-assisted laparoscopic pyeloplasty with the use of a CPU stent can safely and effectively be performed in infants, even with duplicated systems. The CPU stent allows for stent removal in the office, avoiding a second round of anesthesia for the patient. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyMay 4, 2022, 12:00:00 AMV08-07 Robotic Pyeloplasty of Lower Pole Moiety in a 2 Month Old Infant With Cutaneous Pyeloureteral (CPU) Stent. Erratum Volume 207Issue Supplement 5May 2022Page: e715 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amrita Mohanty More articles by this author Clark Judge More articles by this author Anastasia Gliatis More articles by this author Tony Da Lomba More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement PDF DownloadLoading ...

A0788 - Assistant port is unnecessary for robotic-assisted laparoscopic pyeloplasty in children: A non-randomized comparative study

A0788 - Assistant port is unnecessary for robotic-assisted laparoscopic pyeloplasty in children: A non-randomized comparative study

Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutionalcomparisonofoutcomes and learning curves.

Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been widely adopted. However, little has been published detailing the learning curve of MIS, especially in infants. To quantify the learning curve of laparoscopic (LP) and robot-assisted laparoscopicpyeloplasty (RAL-P) for treatment of uretero-pelvic junction obstruction (UPJO) in infants evidenced by number of cases, operative time, success and complications. Between 2009 and 2017, we retrospectively reviewed pyeloplasty cases for treatment of UPJO in infants at three academic institutions. The primary outcome was success. Secondary outcomes were UPJO recurrence, complications, and operative time as a surrogate of skill acquisition. Continuous variables were analyzed by t test, Welch-test, and one-way ANOVA. Non-continuous variables were analyzed by Chi-squared test or Fisher's exact test. Learning curves (LC) were studied by r-to-z transformation and CUSUM. Thirty-nine OP, 26 LP, and 39 RAL-P had mean operative times (OT) of 106, 121, and 151min, respectively. LCs showed plateau in OT after 18 and 13 cases for LP and RAL-P, respectively. RAL-P showed a second phase of further improvements after 37 cases. At 16months follow-up, there were similar rates of success and complications between the three groups. Despite different duration of learning phases, proficiency was achieved in both LP and RAL-P as evidenced by stabilization of operative time and similar success rates and complications to OP. Before and after achievement of proficiency, LP and RAL-P can be safely learned and implemented for treatment of UPJO in infants.

A Comparison Between Laparoscopic and Robot-Assisted Laparoscopic Pyeloplasty in Patients with Ureteropelvic Junction Obstruction.

The aim of this study is to compare the results of laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs. 2 days, respectively, P = 0.029). Laparoscopic and robot-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach.

Comparative Analysis of Robot Assisted Laparoscopy and Laparoscopic Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction

Through the comparison with laparoscopic pyeloplasty, this paper discusses the clinical value of robot assisted laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO). 82 patients with UPJO admitted to the First Affiliated Hospital of Medical College of Zhejiang University from January 2012 to December 2018 were retrospectively analyzed, including 43 patients who underwent robot assisted laparoscopic pyeloplasty (RALP group); Laparoscopic pyeloplasty was performed in 39 cases (LP group). The operation time, reconstruction suture time, intraoperative bleeding, postoperative drainage, postoperative intestinal recovery time, postoperative hospitalization time, hospitalization expenses, surgical complications and follow-up were compared and analyzed between the two groups. There was no significant difference between the two groups in operation time, renal pelvis reconstruction time, intraoperative bleeding, postoperative drainage tube stopping time, postoperative drainage volume and intestinal recovery time (P > 0.05); and the postoperative indwelling time of urinary catheter and postoperative hospital stay in RALP group were shorter than those in LP group (P < 0.05); The hospitalization cost in RALP group was significantly higher than that in LP group. Clavien Grade II complications occurred in 8 cases in LP group, Clavien Grade II complications occurred in 2 cases in RALP group, and there was 1 case of Grade III complications in both groups. The complication rate was 6.79% in RALP group and 23.07% in LP group. There was significant difference between the two groups (P < 0.05). During the postoperative follow-up, hydronephrosis was aggravated in 1 patient in RALP group half a year after operation, and hydronephrosis was aggravated in 1 patient in LP group due to ureteral stone obstruction. Another patient in LP group was found to have more hydronephrosis than before. The success rate was 97.7% in RALP group and 94.8% in LP group. There was no significant difference between the two groups (P > 0.05). Compared with laparoscopy, robot assisted laparoscopic pyeloplasty is a better surgical option. With the reduction of cost, it will gradually replace laparoscopic pyeloplasty.

Retroperitoneal Robotic-Assisted Laparoscopic Pyeloplasty: A 10 Year Experience in a Single Institution.

Introduction: Pelvi-ureteric junction (PUJ) obstruction was traditionally treated with open pyeloplasty. In recent decades, the development of minimally invasive techniques, including laparoscopic and later robotic surgery, has transformed treatment. The transperitoneal approach has most commonly been undertaken, with a few institutions reporting outcomes of the retroperitoneal approach. We report our 10-year experience of retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP). Methods: A prospective database of 160 patients undergoing RALP between February 2010 and November 2019 was analyzed. Data were recorded on demographics, operative details, complications, and success rate. Success was determined as symptomatic improvement and/or an unobstructed renogram. Results: One hundred fifty-two cases (95.0%) were performed by using a retroperitoneal approach, and 8 (5.0%) were performed by using a transperitoneal approach. Mean age was 45.3 ± 17.4 years. Mean operating time was 139.4 ± 45.6 minutes. A surgical drain was placed in 57 (71.3%) of the first 80 cases and 15 (18.8%) of the second 80 cases. Median hospital stay was one night (range 1-27). One case was converted to open pyeloplasty due to dense inflammatory tissue and one to robotic-assisted nephrectomy due to severe adhesions around the PUJ. There were no blood transfusions. There were six major (>grade 2 Clavien-Dindo) postoperative complications in four patients (2.5%). Two (1.3%) grade 3a complications, urine leak and pain after stent removal, required nephrostomy. There were three (1.9%) grade 3b complications: migrated stent requiring ureteroscopy, perirenal hematoma requiring open evacuation, and stent re-insertion. One (0.6%) grade 4 complication required ventilatory support on intensive care. Eighteen patients received follow-up at an alternative hospital, and 13 were lost to follow-up. Of the remaining cases, 94.5% were successful. Conclusions: R-RALP is a safe and effective treatment for PUJ obstruction allowing predictably rapid discharge from hospital without the need for a routine surgical drain. To our knowledge, our study represents the largest single institution experience on RALP using a retroperitoneal approach.

Robotic-assisted laparoscopic pyeloplasty (RALP), for ureteropelvic junction obstruction (UPJO), is an alternative to open pyeloplasty in the pediatric population.

We aimed to evaluate the safety and efficacy of RALP for UPJO in a heterogeneous pediatric population. The medical records of all patients with UPJO who underwent RALP over the last 6years and completed at least 6months of follow-up, were retrospectively reviewed. Data included age, sex, laterality, weight, preoperative and postoperative ultrasound and renal scintigraphy results, operation time, complications, length of hospital stay. We separately examined two groups: low-weight children (< 10kg) and those who underwent RALP after failed pyeloplasty. One hundred patients with a median age of 18months (range 2-216) underwent RALP. The median weight was 10kg (range 4-90). The median operative time, including docking and console time, was 75min (range 40-183). The median hospital stay was one day (range: 1-3). Ninety-eight percent of the patients showed improvement or stable hydronephrosis on postoperative imaging, with a better drainage curve on dynamic radionuclide scans. In two patients, the hydronephrosis worsened. One patient's ipsilateral UVJ was obstructed, and the other patient's UPJO recurred. The operative time was shorter in the low-weight group (p < 0.001), but the length of hospital stay and success rate were not different. Neither the hospital stay nor the success rate of redo RALP patients differed significantly from a control group of primary RALP patients. Our data show that RALP might be utilized as a universal approach in pediatric patients with UPJO.

Systematic Review and Meta-Analysis of Pediatric Robot-Assisted Laparoscopic Pyeloplasty.

Introduction: To perform a systematic review (SR) and meta-analysis (MA) of outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction (UPJ) obstruction in children. Evidence Acquisition: A SR of the English-language literature on surgical techniques and perioperative outcomes of RALP for UPJ obstruction in children was performed without time filters using the MEDLINE (through PubMed), EMBASE, and Cochrane databases in July 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement recommendations. Evidence Synthesis: Overall, 58 studies were selected for qualitative analysis, 46 of which were included in the MA. Nearly all studies included were observational and retrospective, either cohort or case-control. The quality of evidence was assessed using Modified Newcastle-Ottawa Scoring, with the majority of studies scoring medium or high quality. The mean success rate was 95.4% (confidence interval 91.0%-99.3%), over a wide age range. There was a noticeable heterogeneity in reported follow-up length and definitions of success rate. The majority of studies reported length of stay of ∼1 day. The mean overall complication rate was 12%. For studies that reported complication rate by grade, the mean low Clavien grade (Grade 2 or less) complication rate was 9.3% and the mean high Clavien grade (Grade 3 or more) complication rate was 6.5%. Conclusions: Robot-assisted surgery is technically feasible and has been shown to achieve very favorable outcomes for pyeloplasty in children. The evidence, however, is mostly retrospective and from single sites, which introduces potential biases. Further research is needed to further elucidate RALP benefits compared with the open and laparoscopic approach. As a randomized control trial may not be practical in this space, perhaps a prospective multi-institutional design with a uniform reporting system of pediatric RALP is the next step to define its benefits and limits.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Feb 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002330AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Safety and Efficacy of Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair in Infants under 1 Year of Age Even as robotic pediatric urological procedures proliferated, open pyeloplasty continued to be standard of care in infants. The robotic assisted laparoscopic approach was ideal for older children, allowing for meticulous anastomotic repair of the ureteropelvic junction while decreasing recovery times and postoperative pain levels. For open infant pyeloplasty, multiple sites had already demonstrated short length of stay and pain management without opioids. Additionally, because of concerns of the decreased instrument working space in small infants, initial published studies on pediatric robotic pyeloplasty were limited to children weighing more than 10 kg. Increasingly, pediatric centers are offering a robot-assisted laparoscopic approach for these smaller infants as well. In this issue of The Journal, Rague et al (page 432) from Chicago compare outcomes from robotic assisted laparoscopic to open pyeloplasty in infants younger than 1 year of age and less than 10 kg.1 In this retrospective study, pyeloplasty was performed by robotic assisted laparoscopic approach in 83 infants and open approach in 121. Infants in the robotic group tended to be older and to weigh more. The authors did not demonstrate a significant difference in length of stay, postoperative radiographic improvement, 30-day complication rate or need for reoperative pyeloplasty. Currently, the robotic procedures required more hospital resources. The robotic procedures had longer operative times, and approximately a third of the robotic procedures had 2 attending co-surgeons. The dissemination of robotics has changed pediatric urology fellowship training much like it has changed general urology residency. The authors report that the robot-assisted laparoscopic approach has been the preferred method for correction of ureteropelvic junction obstruction in infants at their institution since 2017—so much so that no open infant pyeloplasty was performed from January to June 2020. Certainly, the needs of urology learners are ever changing, and pediatric urology educators should be vigilant. This study highlights that trainees may have limited exposure to open infant pyeloplasty in the near future unless it remains an educational priority. Reference 1. : Safety and efficacy of robot-assisted laparoscopic pyeloplasty compared to open repair in infants under 1 year of age. J Urol 2022; 207: 432. Link, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue 2February 2022Page: 261-261 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stacy T. Tanaka More articles by this author Expand All Advertisement Advertisement Loading ...

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Feb 2022Editorial CommentThis article comments on the following:Safety and Efficacy of Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair in Infants under 1 Year of Ageis a letter which has replyReply by Authors Patricia S. Cho, and Richard N. Yu Patricia S. ChoPatricia S. Cho University of Massachusetts T.H. Chan School of Medicine, Worcester, Massachusetts More articles by this author , and Richard N. YuRichard N. Yu Boston Children’s Hospital, Boston, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002232.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 207(2), pp. 439–440

EP.TH.670Antibiotic Prophylaxis Use In Paediatric Robotic-Assisted Laparoscopic Pyeloplasty: A Systematic Review

Abstract Aim A systematic review was conducted to evaluate the current evidence for prophylactic antibiotic use in paediatric robotic-assisted laparoscopic pyeloplasty (RALP). As pyeloplasties are ‘clean contaminated’ procedures, prophylactic antibiotics are recommended, however, recent evidence suggests that antibiotics may be unnecessary. Prophylactic antibiotics are often either under or over prescribed in paediatric surgery, which increases the risk of developing antibiotic resistance. In general, minimally invasive surgery is associated with less postoperative infections, however, it is not yet clear how RALP compares with other approaches. Recent reviews have indicated prophylactic antibiotics may not decrease postoperative infections, however, there are no clear guidelines. Methods A systematic review was conducted of the following electronic databases: Pubmed, Medline Ovid, The Cochrane Library, TRIP Database, NICE Evidence Search, and EMBASE. The search terms used were: paediatric, pyeloplasty, robotic, antibiotic and were used as keywords as well as in combination as MeSH terms. Results Forty-one articles were retrieved, and after screening for relevance and redundancy, 2 articles remained including a total of 315 pyeloplasties. Prophylactic antibiotics did not reduce the incidence of postoperative UTIs in RALP. Conclusion Prophylactic antibiotics for RALP is not associated with lower rates of UTIs and therefore, may be reserved for patients with risk factors. However, due to the limited data and confounding factors, further research is required to optimise antibiotic stewardship and infection prevention.

Robot-assisted laparoscopic urologic surgery in infants weighing ≤10 kg: A weight stratified analysis

Robot-assisted laparoscopic (RAL) urologic surgery is widely used in pediatric patients, though less commonly in infants. There are small series demonstrating safety and efficacy in infants, however, stratification by infant size has rarely been reported. Whether a cut-off weight, below which RAL surgery is not technically feasible, safe, or efficacious has not be determined. To assess safety and efficacy of RAL urologic procedures in infants <1 year of age, weighing ≤10kg. A single-institution retrospective cohort study of patients <1 year of age, and ≤10kg undergoing RAL pyeloplasty (RALP) or RAL ipsilateral ureteroureterostomy (RALUU) between January 2011 and September 2020 was performed. Demographic, operative, and post-operative data were extracted from the medical record. Patients were stratified by post-hoc weight quartiles. Outcomes, including operative time, total OR time, estimated blood loss (EBL), post-operative length of stay (LOS), post-operative radiographic improvement, and 30-day complications were assessed by weight quartile for each procedure. The Kruskal-Wallis rank test was used to assess differences in continuous outcomes between weight quartiles and Pearson's Chi-squared test was used for categorical outcomes. Of 696 RAL urologic surgeries performed, 101 met eligibility criteria. Median (IQR) age of patients was 7.2 (6.0-9.2) months with median weight of 8.0 (7.2-8.9) kg. The lowest weight was 5.5kg. Procedures performed included 79 RALPs (78.2%), 22 RALUUs (21.8%). We identified 97 patients (94%) with post-operative imaging, with radiographic improvement in 92%. When stratified by weight quartile, there was no difference between groups in median operative time, total OR time, LOS, EBL, or post-operative radiographic improvement for both RALP and RALUU. Post-operative complications were assessed based on Clavien-Dindo classification with the majority of complications (9/12, 75%) in the >50th percentile weight groups. To our knowledge, this is the largest published series of infant RAL urologic procedures, with similar rates of radiographic improvement and post-operative complications to prior published series. There are few prior series of RALP and RALUU in infants ≤10kg, and we show comparable outcomes regardless of patient weight. Our study is limited by the inherent biases of retrospective studies. RAL urologic surgery is technically feasible, safe, and efficacious in infants ≤10kg, without worse outcomes as weight decrease. A cut-off weight, below which RAL surgery should not be performed has yet to be identified.

V09-05 HORSESHOE KIDNEY ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY: A CASE SERIES

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-05 HORSESHOE KIDNEY ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY: A CASE SERIES Daniel Au, David Duchene, and Andrew Zganjar Daniel AuDaniel Au More articles by this author , David DucheneDavid Duchene More articles by this author , and Andrew ZganjarAndrew Zganjar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Horseshoe kidneys are uncommon with an estimated incidence of approximately 1 in 500 persons. Horseshoe kidneys are characterized by arrested developmental ascent and are therefore located lower in the abdomen or pelvis. They are also typically malrotated with ureters passing over the isthmus or anterior to renal parenchyma and have widely variant renal vasculature. As many as 33% will have associated ureteropelvic junction obstruction. Various approaches to horseshoe kidney pyeloplasty have been used over the decades, more recently minimally invasive robotic approaches have been utilized. Owing to the unique anatomy of horseshoe kidneys there are several technical and anatomic considerations that should be considered and which we aim to demonstrate in this video. METHODS: Using a da Vinci robotic surgical system, we performed robotic assisted laparoscopic dismembered pyeloplasty on two patients with horseshoe kidneys and left ureteropelvic junction obstruction. We recorded this case series to demonstrate technical considerations, anatomy, and technique for performing robotic assisted laparoscopic pyeloplasty for horseshoe kidneys with ureteropelvic junction obstruction. RESULTS: Robotic assisted laparoscopic pyeloplasty is a safe and effective approach to the challenging anatomy ureteropelvic junction obstruction in horseshoe kidneys pose. Robotic ports should be placed inferior and medially compared to orthotopic pyeloplasty. CONCLUSIONS: Ureteropelvic junction obstructions are common in horseshoe kidneys and these can initially present in adulthood. Horseshoe kidneys differ from orthotopic kidneys in abdominal location, orientation, and vasculature. Horseshoe kidneys can be approached trans-mesenteric or by reflecting colon and mesentery medially. Ureteropelvic junction obstructions in horseshoe kidneys are typically high inserting with ureter stretched anteriorly over renal parenchyma. The goal of reconstruction is to re-anastomose the ureter to the most dependent portion of the renal pelvis. Crossing vessels are usually not an etiology of obstruction. Symphysiotomy (division of isthmus) is generally not recommended due to increased risk of infection, fistulas, leakages, and bleeding. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e688-e689 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Au More articles by this author David Duchene More articles by this author Andrew Zganjar More articles by this author Expand All Advertisement Loading ...

Abstract 53 - Robot-assisted laparoscopic pyeloplasty – A single centre experience

Abstract 53 - Robot-assisted laparoscopic pyeloplasty – A single centre experience

MP53-07 SINGLE PORT VS. MULTIPORT ROBOTIC PYELOPLASTY: MATCHED ANALYSIS OF PERIOPERATIVE AND FOLLOW-UP OUTCOMES

INTRODUCTION AND OBJECTIVE:In this study we set out to compare perioperative and follow-up outcomes between single port robot-assisted laparoscopic pyeloplasty (SP-LRP) and multiport robot-assisted...