Infant robot-assisted laparoscopic upper urinary tract reconstructive surgery

Bansal, Danesh; Cost, Nicholas G.; Bean, Cynthia; VanderBrink, Brian A.; Schulte, Marion; Noh, Paul H.

doi:10.1016/j.jpurol.2014.01.029

Cited by 36 publications

(14 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Laparoscopy has provided the benefit of better magnification, but this approach does come with a steep learning curve in suturing techniques and tissue manipulation leading to longer operative times (15,16). The suture techniques prove to be especially difficult in children due to smaller tissue and limited abdominal space available for instrument manipulation.…”

Section: Review Articlementioning

confidence: 99%

Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

et al. 2017

View full text Add to dashboard Cite

Hydronephrosis is the most common presentation of ureteropelvic junction (UPJ) obstruction. We reviewed literature, collecting data from Medline, to evaluate the current status of minimally invasive surgery (MIS) approach to pyeloplasty. Since the first pyeloplasty was described in 1939, several techniques has been applied to correct UPJ obstruction, but Anderson-Hynes dismembered pyeloplasty is established as the gold standard, to date also in MIS technique. According to literature several studies underline the safety and effectiveness of this approach for both trans- and retro-peritoneal routes, with a success rate between 81-100% and an operative time between 90-228 min. These studies have demonstrated the safety and efficacy of this procedure in the management of UPJ obstruction in children. Whether better the transperitoneal, than the retroperitoneal approach is still debated. A long learning curve is needed especially in suturing and knotting.

show abstract

Section: Review Articlementioning

confidence: 99%

Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Avery et al [19] recently demonstrated a 91% success rate after RALP in infants. Two small center series have demonstrated the efficacy of RALP in infants with perioperative outcomes similar to open surgery and lower analgesic requirements [20,21]. Collectively, these findings suggest that urologic surgeons are slowly traversing the initial technical limitations of robot-assisted laparoscopy in infants and the application of this technology in younger children is increasing at academic centers.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions

Chan

Durbin‐Johnson

Sturm

et al. 2017

Journal of Pediatric Urology

View full text Add to dashboard Cite

Summary Introduction Patient age and hospital volume have been shown to affect perioperative outcomes after pediatric pyeloplasty. However, to date, there are few multicenter studies that focus on outcomes at teaching hospitals, where many of the operations are performed. Objective The goal was to determine if surgical approach, age, case volume, or other factors influence perioperative outcomes in a large contemporary cohort. Study design Using the clinical database/resource manager (CDB/RM) of the University Health-System Consortium (UHC), children who underwent open, laparoscopic, or robotic pyeloplasty from 2011 to 2014 were identified at 102 academic institutions. Surgery type, age, race, gender, insurance type, geographic region, comorbidities, surgeon volume, and hospital volume were measured. Multivariable mixed-effects logistic regression analysis was used to analyze independent variables associated with complication rates, length of stay (LOS), readmission rates, and ICU admission. Results A total of 2,219 patients were identified. Complication rates were 2.1%, 2.2%, and 3% after open, laparoscopic, and robotic pyeloplasty, respectively. Approximately 12% of patients had underlying comorbidities. Comorbidities were associated with 3.1 times increased odds for complication (p = 0.001) and a 35% longer length of stay (p < 0.001). Age, gender, insurance type, and hospital volume had no effect on complication rates. A trend was seen towards a lower rate of complications with higher surgeon volume (p = 0.08). The mean LOS was 2.0 days in the open pyeloplasty group, 2.4 days in the laparoscopic group and 1.8 days in the robotic group. Patients who underwent robotic surgery had an estimated LOS 11% shorter than those after open surgery (p = 0.03) (table). Patients aged 5 years and under who had robotic surgery had an estimated LOS 14% shorter than those after open surgery (p = 0.06). ICU admission and hospital readmission were not associated with any variables. Discussion The study is limited by the accuracy of the data submitted by the hospitals and is subject to coding error. Complication rates remain low in all three approaches, validating their safety. Patients, including younger patients, had shorter lengths of stay after robotic surgery. The statistically significant differences between approaches were small so clinically there may not be a difference. Conclusions This large multicenter analysis demonstrates that patient comorbidity had the greatest impact upon complication rates and length of stay. Previous work showed that the benefits of laparoscopy were limited to older children. However, this large multicenter study suggests that these benefits now extend to young children with the application of robotics.

show abstract

“…This cut-off appears to be feasible both technically and in terms of anaesthesia [16]. With the introduction of robotic MIS, this goal might even be easier to accomplish [17,18]. Nevertheless, feasibility alone does not make a procedure good for the patient.…”

Section: Discussionmentioning

confidence: 99%

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre

Schroeder

Chrzan²,

Klijn

et al. 2015

Journal of Pediatric Urology

View full text Add to dashboard Cite

Infant robot-assisted laparoscopic upper urinary tract reconstructive surgery

Cited by 36 publications

References 26 publications

Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre

Contact Info

Product

Resources

About