Tubeless outpatient robotic upper urinary tract reconstruction in the pediatric population: short-term assessment of safety

Abstract

Robotic upper urinary tract reconstruction (UUTR) has been widely utilized for surgical management of congenital obstruction. To further reduce morbidity and simplify postoperative care, outpatient robotic pyeloplasty (RP) and robotic ureteroureterostomy (RUU) were performed without ureteral stents, drains, or urethral catheters. The aim of the study was to assess the safety of performing tubeless robotic UUTR as an outpatient procedure. A retrospective review was performed for patients who underwent outpatient tubeless RP and RUU between July 2015 and January 2017. All procedures were primary interventions. No ureteral stents, drains, or urethral catheters were utilized. No regional blocks were utilized. Patients were discharged from the post anesthesia care unit as a scheduled outpatient procedure without an extended stay. Primary outcomes included 30-day complications, emergency room (ER) visits, and readmissions. A total of 19 patients (14 male, 5 female) were identified (RP = 17, RUU = 3), including one patient who underwent staged bilateral RP. Median age was 21.5 months (range 3-220). Median weight was 11.5 kg (range 6-89). Median operative time was 167 min (range 108-249), defined as skin incision to closure. No 30-day complications, ER visits, or readmissions were observed for any patient. The study concludes that pediatric tubeless outpatient robotic UUTR is safe. Further evaluation is needed to assess this approach on a larger scale, as well as assessing the long-term outcomes of tubeless reconstruction.

Predictive factors for early discharge (≤24 hours) and re-admission following robotic-assisted laparoscopic pyeloplasty in children

“…15 More recently, Fichtenbaum et al showed a short series of 17 tubeless RALP in the outpatient setting. 11 In our study, a short-term assessment showed no complications, ER-visits, or readmissions 30 days after surgery. It is our belief that an experienced team and a well-established robotic program can safely perform an early discharge (≤24h) in the majority of patients.…”

“…8,9 More recently, experienced surgeons are observing fast and uneventful recovery by patients undergoing robotic surgery and are pushing to discharge patients earlier or even doing robotic surgery as an outpatient procedure. 10,11 With that in mind, we sought to identify prognostic clinical features that would be associated with an early discharge (≤24h) after robotic pyeloplasty in children. This information would guide and reassure the pediatric urologist when deciding which subset of patients may be discharged with minimal risk.…”

Outpatient Robotic Surgery in Pediatric Urology: Assessment of Feasibility and Short-Term Safety

“…Our early experience with tubeless robotic urinary tract reconstruction in 19 patients displayed excellent outcomes with all patients being discharged from the PACU without ureteral stents, drains or urethral catheters. 10 No 30-day complications, ER visits or readmissions were observed for any patient.…”

Management of ureteropelvic junction obstruction in children—a roundtable discussion

“…According to the available literature, there is not much difference in outcomes but a reduced cost with external stents [29,30]. While there are reports about tubeless robot-assisted pyeloplasties, stenting clearly seems to be the standard treatment [31].…”