Robot-assisted extravesical ureteral reimplantation: Outcomes and conclusions from 78 ureters

Akhavan, Ardavan; Avery, Daniel I.; Lendvay, Thomas S.

doi:10.1016/j.jpurol.2014.01.028

Cited by 83 publications

(37 citation statements)

References 13 publications

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“…However, this imbalance is presumably addressed by applying sampling weights. In accordance, our findings aligned with data from multi-institutional pediatric centers in the U.S. [1,3,37]. Given that Premier is an administrative dataset, we are unable to identify misclassification from coding errors.…”

Section: Discussionsupporting

confidence: 81%

“…Other contemporary, multi-institutional studies have also found inconsequential differences in LOS. Further, the LOS for any type of pediatric pyeloplasty in the U.S. is currently 2 days or less [1,2,4], which leaves a small margin to demonstrate an advantage between the two approaches. We did find that RP reduced the likelihood of prolonged hospitalization, which may be of substantial importance to families when considering missing work, lost wages, and additional childcare costs.…”

Section: Discussionmentioning

confidence: 99%

“…Although there has been a steady decline in pediatric pyeloplasty over the last 15 years [1], robotic pyeloplasty (RP) utilization has increased [2,3] In fact, pyeloplasty is now the most commonly performed robotic procedure in children in the United States [4]. Reasons for this include the advantages inherent to minimally invasive surgery (e.g., small incisions, short recovery time and limited postoperative pain), as well as a distinct technical advantage over laparoscopy provided by articulating robotic wrists.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Varda

Wang

Chung

et al. 2018

Journal of Pediatric Urology

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Summary Introduction Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP. Objective To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure. Study design We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U.S. hospitalizations between 2003 and 2015. ICD9 codes and itemized billing were used to abstract our cohorts. Trends in utilization and cost were calculated and then stratified by age. We used propensity scores to weight our cohorts and then applied regression models to measure differences in the probability of prolonged operative time (pOT), prolonged length of stay (pLOS), complications, and cost. Results During the study period 11,899 pyeloplasties were performed: 75% open, 10% laparoscopic, and 15% robotic. The total number of pyeloplasty cases decreased by 7% annually; OP decreased by a rate of 10% while RP grew by 29% annually. In 2015, RP accounted for 40% of cases. The largest growth in RPs was among children and adolescents. The average annual rate of change in cost for RP and OP was near stagnant: −0.5% for open and −0.2% for robotic. The summary table provides results from our regression analyses. RP conferred an increased likelihood of pOT, but a reduced likelihood of pLOS. The odds of complications were equivalent. RP was associated with a significantly higher median cost, but the absolute difference per case was $1060. Discussion Despite advantages in room and board costs for RP, we found that the cost of equipment and OR time continue to make it more expensive. Although the absolute difference may be nominal, we likely underestimate the true cost because we did not capture amortization, hidden or down-stream costs. In addition, we did not measure patient satisfaction and pain control, which may provide the non-monetary data needed for comparative value. Conclusion Despite an overall decline in pyeloplasties, RP utilization continues to increase. There has been little change in cost over time, and RP remains more expensive because of equipment and OR costs. The robotic approach confers a reduced likelihood of pLOS, but an increased likelihood of pOT. Complication rates are low and similar in each cohort.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Varda

Wang

Chung

et al. 2018

Journal of Pediatric Urology

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“…When compared with open surgery, shorter hospital stay, and less frequent vesical spasms were observed in the intravesical robotic group. Akhavan et al [12] detected 92.3% success rate, and complications at a rate of 10% including febrile urinary system infection, ureteral obstruction, periureteral fluid collection, and ureteral injury. Smith et al [13] compared open surgery, and RALUR technique.…”

Section: Discussionmentioning

confidence: 99%

Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey

Kïbar

Yalçın

Kaya

et al. 2017

Turkish Journal of Urology

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Objective: Robotic surgery is a leading treatment option for minimally invasive surgery and has an increasing popularity in pediatric population, as well. In this article, we reported our case series of robot-assisted laparoscopic surgery in pediatric population. Material and methods:We retrospectively reviewed 29 consecutive pediatric patients who underwent robot-assisted procedures between May 2014 and October 2016. Patient demographics, hospitalization time, estimated blood loss, robotic time and total operative and peri-, and post-operative complications were evaluated.Results: A total of 24 ureter units (18 patients) with grade 1-5 vesicoureteral reflux in 13 female and 5 male, 1 male patient with vesicoureteral stenosis were underwent robot-assisted laparoscopic ureteral reimplantation (RALUR). All patients had complete resolution after surgery. Robot-assisted laparoscopic pyeloplasty (RALP) was performed in 6 patients with ureteropelvic junction obstruction. All patients had complete resolution after surgery. Completely intracorporeal robotic assisted laparoscopic augmentation ileocystoplasty (RLAIC) was applied to two patients with neurogenic bladder. The symptoms and preoperative hydronephrosis were regressed on the first month of follow-up. Robot-assisted laparoscopic reduction cystoplasty (RALRC) was performed in 14-year-old boy with a bladder diverticula and recurrent urinary tract infection. The last case was eleven-year-old female patient with non-functioning kidney. She had recurrent urinary tract infections and was treated with robotic assisted laparoscopic nephrectomy (RALN). Conclusion:Robot-assisted laparoscopic surgery is safe and efficient in pediatric population. Although open surgery is still the gold standard for many pediatric diseases, inherent reconstructive advantages of robotic assisted laparoscopy have a chance to change this view.

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“…Initial success in reflux resolution following treatment with MIS UNC was far more variable, likely as a result of lack of provider experience with such approaches and the resultant learning curve [16–21]. More recent series have found treatment efficacy with MIS UNC to be higher, although typically still not as high as open UNC [9,19,20,22]. MIS UNC has been associated with decreased postoperative pain and shorter LOS, as well as improved cosmesis and corresponding patient/parent satisfaction in some studies [21,23,24], although outpatient open UNC has been reported from several centers [25,26].…”

Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Wang

Tejwani

Cannon

et al. 2016

Journal of Pediatric Urology

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Summary Introduction Open ureteroneocystostomy (UNC) is the gold standard for surgical correction of vesicoureteral reflux (VUR). Beyond single-center reports, there are few published data on outcomes of minimally invasive (MIS) UNC. Our objective was to compare postoperative outcomes of open and MIS UNC using national, population-level data. Method We reviewed the 1998–2012 Nationwide Inpatient Sample to identify pediatric (≤18 years) VUR patients who underwent either open or MIS UNC. Demographics, National Surgical Quality Improvement Program (NSQIP) complications, length of stay (LOS), and cost data were extracted. Statistical analysis was performed using weighted, hierarchical multivariate logistic regression (complications) and negative binomial regression (LOS, cost). Results We identified 780 MIS and 75,976 open UNC admissions. Compared with patients undergoing open UNC, patients who underwent MIS UNC were likely to be older (6.2 versus 4.8 years, p<0.001), publically insured (43 versus 26%, p<0.001), and treated in recent years (90 versus 46% after 2005, p<0.001). MIS admissions were associated with a significantly shorter length of stay (1.0 versus 1.8 days, p<0.001) and higher cost ($9,230 versus $6,304, p=0.002). After adjusting for patient-level confounders (age, gender, insurance, treatment year, and comorbidity), and hospital-level factors (region, bedsize, and teaching status), MIS UNC was associated with a significantly higher rate of postoperative urinary complications such as UTIs, urinary retention, and renal injury (OR 3.1, p=0.02), shorter LOS (RR 0.8, p=0.02), and higher cost (RR 1.4, p=0.008). Discussion Strengths of this study are its large cohort size, long time horizon, national estimation, and cost data. Most prior studies are case-series limited to the size of the institutional cohort. Our analysis of 76,756 operative encounters revealed that open UNC continues to be performed at far greater frequency than MIS UNC, outpacing the latter modality by nearly 100:1. Children treated with MIS UNC had three times greater odds of developing postoperative urinary complications, and MIS UNC patients incurred average costs per admission that were nearly 1.5 times higher than those of children who underwent open UNC. These children were also likely to be older, publically insured, and treated in more recent years. On the other hand, patients treated with MIS UNC required substantially shorter postoperative hospitalization, with an average LOS roughly half that of open UNC cases. Limitations include the retrospective nature of the administrative database, lack of detailed patient-level data, and no available long-term postoperative outcomes. Compared with open surgery, MIS UNC was associated with shorter LOS but higher costs and possibly higher urinary complication rates.

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Robot-assisted extravesical ureteral reimplantation: Outcomes and conclusions from 78 ureters

Cited by 83 publications

References 13 publications

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

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