Pediatric Standard and Robot-Assisted Laparoscopic Pyeloplasty: A Comparative Single Institution Study.

Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
The Journal of urology (Impact Factor: 3.75). 11/2012; DOI: 10.1016/j.juro.2012.09.008
Source: PubMed

ABSTRACT PURPOSE: We report our experience and compare the outcomes between standard and robot-assisted laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in children. MATERIALS AND METHODS: A retrospective cohort study was performed of all children who underwent standard or robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction at a single institution from October 2007 to January 2012. Indications for surgery included symptomatic obstruction and abnormal diuretic renal scan. A successful outcome was defined as resolution of clinical symptoms, improvement of hydronephrosis on ultrasound, stable ultrasound with resolution of symptoms or improvement of the drainage curve on diuretic renal scan. RESULTS: We reviewed 18 patients (median age 8.1 years) who underwent standard and 46 (8.8 years) who underwent robot-assisted laparoscopic pyeloplasty (p = 0.194). Median operative time was 298 minutes (range 145 to 387) for standard and 209 minutes (106 to 540) for robot-assisted laparoscopic pyeloplasty (p = 0.008). Mean hospitalization was similar between the groups (1 day for standard vs 2 days for robot-assisted laparoscopic pyeloplasty, p = 0.246). Narcotic use was similar between the groups. Median followup was 43 months for standard and 22 months for robot-assisted laparoscopic pyeloplasty (p <0.01). Renal ultrasound showed postoperative improvement of hydronephrosis in 85% and stable disease in 15% of patients following robot-assisted laparoscopic pyeloplasty, and improvement in 89.5% and stable disease in 10.5% after standard laparoscopic pyeloplasty. Symptoms resolved in 100% of patients (38 of 38) after robot-assisted laparoscopic pyeloplasty and 87.5% of patients (7 of 8) after standard laparoscopic pyeloplasty. CONCLUSIONS: Robot-assisted laparoscopic pyeloplasty and standard laparoscopic pyeloplasty are effective techniques to correct ureteropelvic junction obstruction, with similar outcomes. Robot-assisted laparoscopic pyeloplasty had a shorter operative time, and its success and complication rates are comparable to standard laparoscopic pyeloplasty.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: We sought to determine current and longitudinal trends in the usage of open (OP), laparoscopic (LP), and robotic pyeloplasties. (RALP) Furthermore, we aimed to describe patient and hospital level characteristics associated with the use of minimally invasive pyeloplasties (MIP) and to compare basic utilization metrics for each approach. Materials/methods: The 2000, 2003, 2006, and 2009 Kid's Inpatient Databases (KID) were used to determine current and longitudinal trends. As a result of a specific billing code for robotic surgery introduced in 2008, the 2009 KID database was used for analysis of RALP. Patient and hospital characteristics examined included: age, gender, race, insurance status, hospital location, and academic status. Utilization metrics of length of stay (LOS) and cost were determined from each modality. Results: In 2009, there were 3354 pediatric pyeloplasties performed in the USA (85% OP, 3% LP, 12% RP). Compared with 2000, this represents an 11.7% decrease in the overall number of pyeloplasties but a progressive increase in MIP from 0.34% in 2000 to 11.7%. Mean patient age was 3.7 years for OP, 9.3 years for LP and 9.9 years for RALP. MIP was more commonly performed in females, Caucasians, patients with private insurance, at urban hospitals and at teaching hospitals. Although length of stay (LOS) in days was statistically lower for MIP (3.46 OP, 2.86 LP, 1.96 RP, p < 0.001), total cost between the groups was not statistically different. On multi-variable logistic regression analysis, age (OR 1.17, p < 0.001) increased the odds of MIP whereas lack of private insurance decreased the odds of MIP (OR 0.62, p = 0.002). Conclusion: Although utilization of MIP is increasing in the USA, especially in older children, OP remains predominant. MIP was associated with a decrease in LOS. The odds of MIP were higher in older children, whereas the lack of private insurance decreased the odds of MIP.
    Journal of Pediatric Urology 07/2014; 10(4). DOI:10.1016/j.jpurol.2014.06.010 · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The benefits of robotic surgery when compared to standard laparoscopy have been well established, especially when it comes to reconstructive procedures. The application of robotic technology to laparoscopic pyeloplasty has reduced the steep learning curve associated with the procedure. Consequently, this has allowed surgeons who are less experienced with laparoscopy to offer this treatment to their patients, instead of referring them to centers of excellence. Robotic pyeloplasty has also proved useful for repairing secondary UPJO, a procedure which is considered extremely difficult using a conventional laparoscopic approach. Finally, the pursuit of scarless surgery has seen the development of laparoendoscopic single site (LESS) procedures. The application of robotics to LESS (R-LESS) has also reduced the difficulty in performing conventional LESS pyeloplasty. Herein we present a literature review with regards to robotic-assisted laparoscopic pyeloplasty. We also discuss the benefits of robotic surgery with regards to reconstruction of the lower urinary tract.
    Indian Journal of Urology 07/2014; 30(3):293-9. DOI:10.4103/0970-1591.128503
  • [Show abstract] [Hide abstract]
    ABSTRACT: • To critically analyse outcomes for robot-assisted (RP) versus conventional laparoscopic (LP) or open (OP) pyeloplasty by systematic review and meta-analysis of the literature. Patients and Methods• Studies published up to December 2013 were identified from multiple literature databases.• Only comparative studies investigating RP versus LP or OP in children were included.• Meta-analysis was performed using random effects modeling. Heterogeneity, subgroup analysis, and quality scoring were assessed. Effect sizes were estimated by pooled odds ratios and weighted mean differences.• Primary outcomes investigated were operative success, re-operation, conversions, post-operative complications, and urinary leakage. Secondary outcome measures were estimated blood loss (EBL), length of hospital stay (LOS), operating time (OT), analgesia requirement, and cost. Results• Twelve observational studies met inclusion criteria, reporting outcomes of 384 RP, 131 LP, and 164 OP procedures.• No randomised controlled trials were identified.• Pooled analysis determined no significant differences between RP and LP or OP for all primary outcomes. Significant differences in favour of RP were found for LOS (versus LP and OP). Borderline significant differences in favour of RP were found for EBL (versus OP).• OT was significantly longer for RP versus OP.• Limited evidence indicates lower opiate analgesia requirement for RP (versus LP and OP), higher total costs for RP versus OP, and comparable costs for RP versus LP. Conclusion• Existing evidence shows largely comparable outcomes amongst surgical techniques available to treat pelvi-ureteric junction obstruction in children.• RP may offer shortened LOS, lower analgesia requirement (versus LP and OP), and lower EBL (versus OP); but compared to OP, these gains are at the expense of higher cost and longer OT.• Higher quality evidence from prospective observational studies and clinical trials is required, as well as further cost-effectiveness analyses. Not all perceived benefits of RP are easily amenable to quantitative assessment.
    BJU International 02/2014; 114(4). DOI:10.1111/bju.12683 · 3.13 Impact Factor


Available from
Jun 5, 2014