Early Robotic-Assisted Laparoscopic Pyeloplasty for Infants Under 3 Months With Severe Ureteropelvic Junction Obstruction

Abstract

Objective: To present our primary experience of robotic-assisted laparoscopic pyeloplasty (RALP) for severe ureteropelvis junction obstruction (UPJO) infants under 3 months.Methods: We performed a retrospective study of 9 infants under 3 months who underwent RALP for severe UPJO between April 2017 and March 2019 in our center. The severe UPJO was defined as infants with severe hydronephrosis (Society of Fetal Urology grades III or IV, anteroposterior diameter >3 cm or split renal function <40% or T 1/2 >20 min) involving bilateral, solitary kidney, or contralateral renal hypoplasia UPJO at the same time. All clinical, perioperative, and postoperative information was collected.Results: There were four bilateral UPJO cases, two solitary kidney UPJO cases and three unilateral UPJO with contralateral renal hypoplasia cases included. One single surgeon performed RALP on all of the infants. The mean age of the infants was 1.62 ± 0.54 months. The mean operative time was 109.55 ± 10.47 min. The mean estimated blood loss was 19.29 ± 3.19 ml, and the mean length of hospital stay was 5.57 ± 0.73 days. According to the ultrasonography results, all patients had a significant recovery of renal function at 12 months after the operation.Conclusions: To maximize the protection of renal function, early RALP is a safe and feasible option for the treatment of severe UPJO in infants under 3 months.

Outcome analysis of immediate and delayed laparoscopic pyeloplasty in infants with severe ureteropelvic junction obstruction

“…The pelvis was cut above the obstruction tissue and carefully trimmed to facilitate the anastomosis. Thereafter, a 5-0 absorbable was used to suture the lowest point of the ureteral segment and the pelvis end ( 18 ). Before the anterior anastomoses were started, a properly sized indwelling double- J stent (Bard, U.S.) was inserted and prophylactic antibiotics were initiated until the double-J stent was removed on the 6–8th week after surgery.…”

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

“…• The limited number or size of studies • Important flaws in study design or methods • Inconsistency of findings across individual studies • Gaps in the chain of evidence • Findings not generalizable to routine primary care practice • Lack of information on important health outcomes More information may allow estimation of effects on health outcomes 2. Robotic surgery can be considered mainly in patients weighing more than 10 kg and older than one year [8,9,12,15,16,18,[20][21][22][23] (Grade A-Level High) 3. Based on the experience at individual centers, robotic surgery can also be performed in selected patients of lower weight or age [8,9,12,15,18,[20][21][22][23] (Grade C-Level High) 4.…”

“…Robotic surgery can be considered mainly in patients weighing more than 10 kg and older than one year [8,9,12,15,16,18,[20][21][22][23] (Grade A-Level High) 3. Based on the experience at individual centers, robotic surgery can also be performed in selected patients of lower weight or age [8,9,12,15,18,[20][21][22][23] (Grade C-Level High) 4. Despite the need for a more complex organization, there are no contraindications to performing robotic surgery in facilities outside of pediatric centers [6] (Grade C-Level High)…”

Modified robotic-assisted laparoscopic pyeloplasty in children for ureteropelvic junction obstruction with long proximal ureteral stricture: The “double-flap” technique

“…After general anesthesia, the child was placed 45-60 degrees from the horizontal direction (12). The trocar position has been described in an article previously published by our team (13). After the stricture ureter was located, we measured the length of the segment with a silk thread (Figure 2).…”