Robot-assisted laparoscopic pyeloplasty: Multi-institutional experience in infants

Avery, Daniel I.; Herbst, Katherine W.; Lendvay, Thomas S.; Noh, Paul H.; Dangle, Pankaj P.; Gundeti, Mohan S.; Steele, Matthew C.; Corbett, Sean T.; Peters, Craig A.; Kim, Christina

doi:10.1016/j.jpurol.2014.11.025

Cited by 84 publications

(54 citation statements)

References 20 publications

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“…However, there has been an increase in RALP in infants [6]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the limitations of a retrospective database study, we were unable to determine the conversion rates to the open approach. To our knowledge, conversion rates for pediatric RALP range from zero to 1.4% from multi-institution studies to zero in single center studies [19,26,27]. Complications managed on an outpatient basis or possibly at hospitals not within the UHC database were not captured.…”

Section: Discussionmentioning

confidence: 99%

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

Chan

Durbin‐Johnson

Sturm

et al. 2017

Journal of Pediatric Urology

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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.

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Section: Discussionmentioning

confidence: 99%

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

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show abstract

“…Thus, the applicability of robotic surgery in infants is currently being tested. Avery et al [17] recently reported the cumulative experience of robotic pyeloplasty in 60 infants from five centres. The instrumentation for robotic surgery is much larger (12 mm or 8.5 mm camera port, with 8 mm or 5 mm instruments) [17] than the mini-laparoscopic equipment used by our unit in LP.…”

Section: Discussionmentioning

confidence: 99%

“…However, there may be some disadvantages, such as increased cost and longer operation times (including the time required to dock the robot). In addition, the use of larger ports may result in some port-site hernias which require formal closure [17].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic pyeloplasty in infants: Single-surgeon experience

Chandrasekharam

2015

Journal of Pediatric Urology

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“…It may be argued that the potential benefits of less pain and reduced morbidity associated with laparoscopy may not be apparent in infants. On the other hand, there are emerging multicenter reports of robotic-assisted laparoscopic pyeloplasties in infants, using much larger trocars than the 3mm minilaparoscopic equipment used by us 17 …”

Section: Accepted Manuscriptmentioning

confidence: 99%

Laparoscopic repair of congenital midureteric strictures in infants and children

Chandrasekharam

2015

Journal of Pediatric Surgery

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Robot-assisted laparoscopic pyeloplasty: Multi-institutional experience in infants

Cited by 84 publications

References 20 publications

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

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

Laparoscopic pyeloplasty in infants: Single-surgeon experience

Laparoscopic repair of congenital midureteric strictures in infants and children

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