Robotic Management of Urolithiasis in the Pediatric Population

Ballesteros, Natalia; Snow, Zachary A; Moscardi, Paulo Renato Marcelo; Ransford, George; Gómez, Pablo; Castellán, Miguel

doi:10.3389/fped.2019.00351

Cited by 12 publications

(23 citation statements)

References 39 publications

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“…Furthermore, ESWL is not recommended in children with stone burdens larger than 25 mm [21]. Laparoscopic and robot-assisted approaches have been reported as viable treatment options in selected patients with large stones, anomalies of collecting system and complex stone burdens [7][8][9][10]. These indications were supported by a conspicuous evidence in the adult population [13][14][15][16]22].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of urinary tract stones, especially large stone burdens, may be challenging in children and require multiple procedures [ 18 ]. The American Urological Association (AUA) and European Association of Urology (EAU) guidelines [ 8 , 19 , 20 ] for treatment of urinary tract stones in adults indicated that PCNL is the treatment of choice for kidney stones > 2 cm; whereas, flexible URS/RIRS and ESWL are the first-line therapy for stones < 2 cm. The same principles are also applied in children and adolescents [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The American Urological Association (AUA) and European Association of Urology (EAU) guidelines [ 8 , 19 , 20 ] for treatment of urinary tract stones in adults indicated that PCNL is the treatment of choice for kidney stones > 2 cm; whereas, flexible URS/RIRS and ESWL are the first-line therapy for stones < 2 cm. The same principles are also applied in children and adolescents [ 8 ]. However, multiple treatment sessions may be required to achieve stone clearance [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…These selected clinical conditions are better managed using an open or conventional laparoscopic approach [ 6 , 7 ]. This is also supported by the European Association of Urology (EAU) guidelines for the management of urinary stone disease in children, stating that open or laparoscopic approach may be inevitable in such situations [ 8 ]. However, the morbidity of open surgery can be significant [ 9 ], whereas drawbacks of laparoscopic stone surgery include challenges with ureteral stenting, limited dissection and intra-corporeal suturing, as well as increased risk of complications such as urinary leakage [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is still limited evidence regarding the role of RALS in the management of pediatric urolithiasis [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…However, there is still limited evidence regarding the role of RALS in the management of pediatric urolithiasis [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2021

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Robotic Pediatric Renal Surgery

Nassau

Castellán

Casale

et al. 2022

Robotic Urologic Surgery

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Robotic-assisted pyeloplasty in children: a systematic review of the literature

Esposito¹,

Cerulo²,

Lepore³

et al. 2023

J Robotic Surg

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Robotic pyeloplasty has become a natural progression from the development of open, then laparoscopic procedures to treat pediatric patients with ureteropelvic junction obstruction (UPJO). Robotic-assisted pyeloplasty (RALP) is now considered a new gold standard in pediatric MIS. A systematic review of the literature retrieved from PubMed and published in the last 10 years (2012–2022) was performed. This review underlines that in all children except the smallest infants, where the open procedure has benefits in terms of duration of general anesthetic and there are limitations in the size of instruments, robotic pyeloplasty is becoming the preferred procedure to perform in patients with UPJO. Results for the robotic approach are extremely promising, with shorter operative times than laparoscopy and equal success rates, length of stay and complications. In case of redo pyeloplasty, RALP is easier to perform than other open or MIS procedures. By 2009, robotic surgery became the most used modality to treat all UPJO and continues to grow in popularity. Robot-assisted laparoscopic pyeloplasty in children is safe and effective with excellent outcomes, even in redo pyeloplasty or challenging anatomical cases. Moreover, robotic approach shortens the learning curve for junior surgeons, who can readily achieve levels of expertise comparable to senior practitioners. However, there are still concerns regarding the cost associated with this procedure. Further high-quality prospective observational studies and clinical trials, as well as new technologies specific for the pediatric population, are advisable for RALP to reach the level of gold standard.

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Robotic Management of Urolithiasis in the Pediatric Population

Cited by 12 publications

References 39 publications

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

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

Robotic Pediatric Renal Surgery

Robotic-assisted pyeloplasty in children: a systematic review of the literature

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