Long-Term Experience and Outcomes of Robotic Assisted Laparoscopic Pyeloplasty in Children and Young Adults

Minnillo, Brian J.; Cruz, José Arnaldo Shiomi da; Sayao, Rogerio; Passerotti, Carlo C.; Houck, Constance S.; Meier, Petra M.; Borer, Joseph G.; Diamond, David A.; Retik, Alan B.; Nguyen, Hiep T.

doi:10.1016/j.juro.2010.11.056

Cited by 129 publications

(72 citation statements)

References 13 publications

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“…According to the outcomes of these studies robotic pyeloplasty confers important advantages as higher success rates, lower amounts of bleeding, and shorter hospital stay. [13,[16][17][18][19][20][21][22][23] Currently, in centers with adequate experience, and technological facilities, cases with UPJO are tended to be more frequently managed with minimally invasive methods as laparoscopic, and robotic pyeloplasties. In a single-center study, minimally invasive methods used in pyeloplasties were compared.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Ener

Altinova

Canda

et al. 2014

Turkish Journal of Urology

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Objective: We evaluated outcomes of our robot-assisted laparoscopic transperitoneal pyeloplasty (RALP) procedures. Material and methods:Between July 2011 and March 2014, 18 RALP procedures were performed at our instutition. Ureteropelvic junction obstruction (UPJO) diagnosis was made based on clinical presentation and intravenous urography. All patients underwent basal and diuretic isotopic renography to evaluate the degree of obstruction and impaired renal function. Anderson-Hynes dismembered pyeloplasty technique was used with a transperitoneal approach by using the da Vinci-S 4-arm surgical robot. Outcomes were assessed retrospectively.Results: Mean patient age was 31.3±11.7 (13-62) years. Male: female ratio was 9: 9. All procedures were primary surgeries. Of 18 patients, 10 (55.5%) had a crossing vessel and 8 (44.5%) had intrinsic obstruction. Conclusion: Due to our experience, RALP is a safe and feasible minimally invasive approach in patients with UPJO with excellent surgical and functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Ener

Altinova

Canda

et al. 2014

Turkish Journal of Urology

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“…The Children's Hospital Boston experience with robotic pyeloplasty in 155 patients during [2002][2003][2004][2005][2006][2007][2008][2009] has been reported by Minnillo et al, demonstrating long-term surgical success and complication rates comparable to open surgery. [25] 4. Ureterocalicostomy Indication: Robotic-assisted ureterocalicostomy (RAUC) is a potential option in patients with UPJO and significant lower pole caliectasis, patients with failed pyeloplasty and a minimal pelvis, or patients with an exaggerated intrarenal pelvis.…”

Section: Outcomementioning

confidence: 99%

Robotic-assisted laparoscopic surgery in pediatric urology: an update

Kojima¹,

Khurgin²,

Casale³

2012

Turkish Journal of Urology

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Laparoscopic procedures for urological diseases in children, such as nephrectomy, pyeloplasty and orchiopexy, have proven to be safe and effective with outcomes comparable to open procedures. The main drawback has been the relatively steep learning curve for this procedure that is associated with technical difficulties such as suturing and anastomosis. More recently, robotic-assisted laparoscopic surgery (RAS) has gained enormous popularity in adult urology and is increasingly being adopted around the world; however, few pediatric urology series have been reported. RAS has several advantages over conventional laparoscopic surgery, mainly the simplification and precision of exposure and suturing. The robotic arms move in real time with an increased degree of freedom and a magnified, 3-dimensional view. These features render RAS ideal for complex reconstructive surgery in a pediatric urological population. This review discusses the role of RAS in pediatric urology, provides technical aspects of RAS and offers a critical summary of current knowledge on its indications and outcomes. Almost all operations that are classically performed as open or conventional laparoscopic reconstructive surgeries for children with urological anomalies could be replaced by RAS and this procedure may be established as an alternative minimally invasive surgery in the future.Key words: Laparoscopy; minimally invasive surgery; pediatrics; robotics; urinary tract reconstruction; urology. ÖZETÇocuklarda nefrektomi, piyeloplasti ve orşiopeksi gibi ürolojik hastalıklar için laparoskopik prosedürlerin, açık prosedürlerle kıyaslanabilir sonuçlar ile birlikte, güvenli ve etkili olduğu kanıtlanmıştır. Bu prosedür-lerin, sütür atma ve anastamoz gibi teknik zorluklarla ilişkili göreceli dik öğrenme eğrisi olması başlıca dezavantaj olmaktadır. Son zamanlarda, robot yardımlı laparoskopik cerrahi (RAS) erişkin ürolojisinde olağanüstü bir popülerlik kazanmıştır ve bütün dünyada giderek artan bir şekilde kabul görmektedir; buna karşın, bir kaç pediatrik üroloji serisi yayınlanmıştır. RAS konvansiyonel laparoskopik cerrahiye kıyasla bir kaç avantaja sahiptir; bunların başlıcaları pozlama ve sütur atmanın kolaylığı ve hassasiyetidir. Robot kollar artmış bir serbestlik derecesinde ve büyütülmüş 3 boyutlu bir bakış açısıyla gerçek zamanlı olarak hareket etmektedir. Bu özellikler RAS'ı pediatrik ürolojik populasyonda kompleks rekonstrüktif cerrahi için ideal yapmaktadır. Bu derleme pediatrik ürolojide RAS'ın rolünü tartışmakta, RAS'ın teknik yönlerini bildirmekte ve endikasyonları ve sonuçları hakkında güncel bilgilerin eleştirel bir özetini sunmaktadır. Ürolojik anomalisi olan çocuklar için açık veya konvansiyonel laparoskopik rekonstrüktif cerrahi şeklinde klasik olarak yapılan hemen hemen tüm operasyonların yerine RAS yapılabilir ve bu prosedür gelecekte alternatif bir minimal invaziv cerrahi olarak yerleşebilir.

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“…Additionally, parent satisfaction was reported to be greater in robotic pyeloplasty than with open surgery regarding amount of cosmesis and recovery [6]. Table 1 summarizes selected series of the published robotic pyeloplasty literature with highest number of patients [7][8][9][10][11][12][13][14]. More than 95% success rates were reported by most series.…”

mentioning

confidence: 99%

“…Some of these series include both primary and secondary cases that might have an impact on operation time [7][8][9][10][11][12][13][14]. Mean blood loss was less than 100 cc in most series [7][8][9][10][11][12][13][14]. Duration of hospital stay was between 1-2.5 days which is one of the main advantages minimally invasive surgery including laparoscopic approach [7][8][9][10][11][12][13][14].…”

mentioning

confidence: 99%

“…Mean blood loss was less than 100 cc in most series [7][8][9][10][11][12][13][14]. Duration of hospital stay was between 1-2.5 days which is one of the main advantages minimally invasive surgery including laparoscopic approach [7][8][9][10][11][12][13][14].Robotic laparoendoscopic single-site (LESS) pyeloplasty is one of the recently developing techniques that attract the attention of both urologists and patients. A number of reports exist in the literature related with this subject.…”

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confidence: 99%

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Robotic Pyeloplasty: Step by Step Surgical Technique

Canda¹

2013

Adv Robot Autom

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Uretero-pelvic junction obstruction (UPJO) leads to impaired transport of urine from the renal pelvis to the ureter and might lead to deterioration of renal function. Congenital causes, acquired factors and presence of an aberrant crossing vessel are the etiologic factors. Surgical correction is applied in the treatment of UPJO. Minimally invasive approaches including laparoscopic and robotic approaches are increasingly being performed. Robotic pyeloplasty is most frequently applied transperitoneally. The outcomes of robotic (transperitoneal and retroperitoneal), laparoscopic and open pyeloplasties seem to be similar due to the published literature. Robotic approach has the advantages of enabling quicker tissue dissection, reconstruction, intracorporeal suturing, antegrade double-J stenting and better ergonomics for the console surgeon. Although cost is an issue for robotic surgery, being a minimally invasive surgical approach with excellent functional and surgical outcomes are the advantages in addition to better cosmetic results for the patient. In this paper, surgical technique of robotic pyeloplasty is explained and outcomes of this approach are summarized by reviewing the literature. respectively. An endoscopic suction is used for irrigation and suction of intra-abdominal body fluids (urine and blood) and smoke. An endoscopic needle holder is used to introduce and remove suture materials into the abdominal cavity. An endoscopic grasper is used to remove tissue pieces such as excised UPJ section.Following identification of the white line of Toldt, colon is identified and mobilized medially (Figure 2a and 2b). Thereafter, ureter is detected in the retroperitoneum and dissected off the surrounding structures (Figure 3a and 3b). Then, ureter is dissected up to the renal pelvis (Figure 4a-c). It is important to note and not to damage the presence of a crossing vessel that might exist in the retroperitoneum and that might cause UPJ obstruction, compressing the ureter and supplying the kidney (Figure 4a-4c). Renal pelvis is identified and fat tissue overlying the renal pelvis is dissected off. In most cases, renal pelvis appears quiet dilated and hydronephrotic ( Figure 5).A stitch by using 4/0 vicrly suture with atraumatic needle is put on the anterior site of the upper ureter in order to mark the anterior surface ( Figure 6). Then, ureter is cut above the suture completely ( Figure 7). The obstructed UPJ tissue is excised and removed for histopatho logic investigation. Thereafter, ureter is spatulated at its cut end posteriorly (Figure 8). Dilated and hydronephrotic renal pelvis is cut and removed for histopathological evaluation (Figure 9a-9c). As a result, the size and capacity of the renal pelvis is reduced to its normal limits. Figure 10 shows the appearance of the prepared renal pelvis and ureter for anastomosis. A JJ stent is inserted through the 10 mm sized assistant port into the ureter (Figure 11a). Thereafter, anastomosis between the spatulated ureter and the renal pelvis is initiated starting ...

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Long-Term Experience and Outcomes of Robotic Assisted Laparoscopic Pyeloplasty in Children and Young Adults

Cited by 129 publications

References 13 publications

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Robotic-assisted laparoscopic surgery in pediatric urology: an update

Robotic Pyeloplasty: Step by Step Surgical Technique

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