Robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidneys: results of a multicentric study

Esposito, Ciro; Masieri, Lorenzo; Blanc, Thomas; Manzoni, Gianantonio; Silay, Mesrur Selçuk; Escolino, Maria

doi:10.1007/s00345-019-02632-x

Cited by 20 publications

(7 citation statements)

References 25 publications

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“…9,13,19 RALP is currently the most frequent procedure performed in the pediatric population, and the only one where outcomes have been proved to be at least comparable to the open or laparoscopic techniques. 11,12,20 Many other applications of RAS, including ureteral reimplantation, appendico-vesicostomy creation, bladder neck reconstruction, and kidney stone surgery, have been described in children but further evidence is needed to validate these indications. 8,9,13,21 Despite all the reported advantages, there are still several limitations to a large-scale application of RAS in pediatric population, as demonstrated by lack of large case series and comparative studies between RAS and traditional approaches.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Esposito

Masieri

Castagnetti

et al. 2023

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Pediatric robot-assisted surgery (RAS) is gaining increasing acceptance. We aimed to assess the diffusion of pediatric RAS in Italy, the training period, indications, preliminary outcomes, and limitations. Materials and Methods: An online questionnaire-based survey was performed. The data about robotic activity of 9 Italian Pediatric Surgery units were collected and analyzed. Results: Most of the participating centers (7/9, 77.8%) started RAS less than 5 years ago with only 2 centers (22.2%) performing RAS since 2010. The training included dry-lab in 5/9 centers (55.5%), wet-lab in 5/9 centers (55.5%), and robot simulator in 7/9 centers (77.8%), followed by an exam to obtain a certificate. The average duration of training was 23.7 hours (range 5-50). A total of 209 robotic procedures was performed in all centers during the period 2010-2018 and included 119 urological (56.9%), 31 gynecological (14.8%), 41 gastrointestinal (19.6%), 12 oncological (5.7%), and 6 other (2.8%) procedures. The docking time significantly fell down after 18 robotic procedures (P = .001). Intraoperative complications were recorded in 4 cases (1.9%). Conversion to laparoscopy was needed in 4 cases (1.9%) whereas conversion to open was required in 6 cases (2.8%). Postoperative complications occurred in 17/209 cases (8.1%) and were graded Clavien I-II in 14 cases (6.7%) and Clavien IIIb in only 4 cases (1.9%). Conclusions: Our study confirmed that RAS has still a limited diffusion in Italy for pediatric patients. Before starting robotic activity, pediatric surgeons have to obtain a certificate after a virtual and experimental training period. A mentorship clinical period of 10 cases under supervision of a proctor is also needed. The main indications in children remain reconstructive urological procedures. RAS is safe in children but its applications are currently limited to patients older than 2 years and with a weight >15 kg, due to the size of robotic ports.

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Section: Discussionmentioning

confidence: 99%

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Esposito

Masieri

Castagnetti

et al. 2023

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Nevertheless, a minimally invasive technique known as LP has emerged as a new gold standard for treating hydronephrosis in children, and has been increasingly adopted since its introduction in the 1990s ( 18 ). In recent years, robotic technology has been developing rapidly and becoming more widely used in pyeloplasty ( 19 ). The advent of robotic technology has mitigated some of the technical challenges associated with laparoscopic surgery, providing surgeons with advanced EndoWrist instrumentation and three-dimensional visualization ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Hydronephrosis in pediatric horseshoe kidneys: a comparative analysis of open and laparoscopic pyeloplasty and the influence of obstruction causes

Shao,

Yang,

et al. 2023

Transl Androl Urol

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Background Horseshoe kidney (HSK) represents a unique challenge for performing pyeloplasty due to its anomalous anatomy. Our study aimed to report our results in treating children with hydronephrosis in HSK and to investigate the differences in prognosis based on the cause of obstruction and the surgical approach. We also aimed to share our experiences by characterizing the success rates and complications after surgery. Methods We retrospectively reviewed the clinical data of hydronephrosis patients with HSK who were treated with pyeloplasty from August 2009 to June 2022. The patients were grouped according to different surgical methods and causes of obstruction, and then the clinical characteristics and outcomes were analyzed. Results Thirty-one patients were included in this retrospective cohort observational study, and surgical success was achieved in 80.6% (25/31) of patients. There was no significant difference in complications between open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) groups (2/16 vs. 4/15, P=0.374). At 6 and 12 months postoperatively, both OP and LP groups experienced a decrease in anteroposterior pelvic diameter (APD) and the ratio of APD to the thickness of renal parenchyma (P/C ratio), accompanied by an increase in renal parenchymal thickness. Two patients of reobstruction were caused by missed crossing vessels in primary operation. The success rate of patients with crossing vessels (62.5%) was significantly lower than that of patients without crossing vessels (100%) (P=0.018). Conclusions Our study found that intrinsic obstruction, crossing vessels, and high insertion were the main causes of hydronephrosis in HSK, with missed crossing vessels being the primary cause of reobstruction. Our results demonstrate that both OP and LP are safe and effective in treating hydronephrosis in HSK patients.

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“…A multicenter study reported that robot-assisted laparoscopic pyeloplasty (RALP) was a safe and feasible approach with satisfactory efficacy in children who had HSK [8]. A study by Guliev reported on 130 patients with HSK, 10 (7.7%) of whom had hydronephrosis treated with laparoscopic pyeloplasty, which achieved a success rate of 90% [9].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy combining with ureteroscopy for horseshoe kidney accompanying with duplicate kidney and a ureteral calculus: a case report

Zhang

Gao

et al. 2020

BMC Urol

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Background: Horseshoe kidney (HSK) is a common renal fusion anomaly, occurring in about 1 in 400-600 individuals. In addition, the incidence of duplicated collecting system is about 0.8%. Case presentation: This report documents an extremely rare case, which was treated by multiple procedures in the same operative session to accomplish laparoscopic amputation of the HSK isthmus, resection of duplicate kidney and ureteroscopic lithotripsy. Conclusion: Results showed that minimally invasive surgery with use of multiple endoscopes may be a feasible choice for this patient population with complicated comorbid renal conditions.

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Robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidneys: results of a multicentric study

Cited by 20 publications

References 25 publications

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Hydronephrosis in pediatric horseshoe kidneys: a comparative analysis of open and laparoscopic pyeloplasty and the influence of obstruction causes

Laparoscopy combining with ureteroscopy for horseshoe kidney accompanying with duplicate kidney and a ureteral calculus: a case report

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