Robot-assisted laparoscopic surgery for treatment of urinary tract stones in children: report of a multicenter international experience

Abstract

This study aimed to report a multi-institutional experience with robot-assisted laparoscopic surgery (RALS) for treatment of urinary tract stones in children. The medical records of 15 patients (12 boys), who underwent RALS for urolithiasis in 4 international centers of pediatric urology over a 5-year period, were retrospectively collected. The median patient age was 8.5 years (range 4–15). Eleven/fifteen patients (73.3%) had concurrent uretero–pelvic junction obstruction (UPJO) and 2/15 patients (13.3%) had neurogenic bladder. Stones were in the renal pelvis in 8/15 (53.3%), in the lower pole in 3/15 (20%), in the bladder in 2/15 (13.3%), and in multiple locations in 2/15 (13.3%). One patient (6.6%) had bilateral multiple kidney stones. The median stone size was 10.8 mm (range 2–30) in upper tract location and 27 mm (range 21–33) into the bladder. Eleven patients with concomitant UPJO underwent simultaneous robot-assisted pyelolithotomy and pyeloplasty in 12 kidney units. Two patients with isolated staghorn stones received robot-assisted pyelolithotomy. Robot-assisted cystolithotomy was performed in two patients with bladder stones. The median operative time was 131.8 min (range 60–240). The stone-free rate was 80% following initial surgery and 100% after secondary treatment. Clavien 2 complications (hematuria, infections) were recorded in 5/15 patients (33.3%). Three/fifteen patients (20%) with residual renal stones were successfully treated using ureterorenoscopy (Clavien 3b). RALS was a feasible, safe and effective treatment option for pediatric urolithiasis in selected cases such as large bladder stones, bilateral kidney stones, staghorn stones or concomitant anomalies such as UPJO requiring simultaneous pyeloplasty.

Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives

“…Although the majority of children with urinary stones are managed via ESWL, URS, RIRS, or PCNL, the use of MIS has significantly increased over the last two decades ( 27 , 28 ).…”

Comparison of the Safety and Efficacy of Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment of Bladder Stones in Children

“…Since then, many studies have confirmed the safe and efficient use of both modalities in the treatment of pediatric bladder stones. Recently, minimally invasive surgery (MIS) has shown to be safe and effective in removing big bladder stones [11]. The superior advantage of MIS is the possibility of removing bladder stones through the navel, utilizing an endobag, without crushing them [11].…”

“…Recently, minimally invasive surgery (MIS) has shown to be safe and effective in removing big bladder stones [11]. The superior advantage of MIS is the possibility of removing bladder stones through the navel, utilizing an endobag, without crushing them [11]. Moreover, robot-assisted laparoscopic surgery has demonstrated efficacy in the treatment of large-volume stones, especially in conditions requiring simultaneous reconstruction [12].…”

Primary hyperoxaluria type 1: urologic and therapeutic management

“…Open or laparoscopic approaches are seldom used, especially trans parenchymal approaches, due to their greater invasiveness. Several series exist for robot-assisted laparoscopic approaches to stones in children in the non-PH population [ 1 , 2 ]. This may work well for selected patients as a one-time treatment.…”

“…Reoperative robotic pyeloplasty in children takes longer and has a longer associated length-of-stay [ 3 , 4 ], as well as a higher rate of complications than comparable series of primary cases [ 4 , 5 ]. Similarly, the stone procedures reported are largely in older children and teens [ 1 , 2 ]; patients with PH often present as infants and toddlers, creating additional surgical challenge and risk.…”