Infant robotic pyeloplasty: Comparison with an open cohort

Bansal, Danesh; Cost, Nicholas G.; DeFoor, William; Reddy, Pramod; Minevich, Eugene; VanderBrink, Brian A.; Alam, Shumyle; Sheldon, Curtis A.; Noh, Paul H.

doi:10.1016/j.jpurol.2013.10.016

Cited by 61 publications

(38 citation statements)

References 26 publications

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“…Operative time and hospitalization stay in our study is very low, compared with a recent series of open or laparoscopic pyeloplasty in infants ( 24 , 25 ). We believe this is one of the major advantages of this technique, in addition to the absence of scars or sequelae.…”

Section: Discussioncontrasting

confidence: 56%

Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants

et al. 2016

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PurposeThe aim of this study is to analyze results of retrograde endopyelotomy with cutting balloon for treatment of ureteropelvic junction obstruction (UPJO) in infants.MethodsWe routinely treat patients with UPJO under 18 months of age with retrograde high-pressure balloon dilatation of the pelviureteric junction (PUJ). During the procedure, in these cases where narrowing at the PUJ persists, endopyelotomy with cutting balloon is performed. Endopyelotomy is performed over guidewire with 5-mm Cutting Balloon™ under fluoroscopic control. Double-J stents is left in situ for 4 weeks. We retrospectively analyzed the postoperative, clinical, and radiological outcome infants treated with cutting balloon endopyelotomy between 2007 and 2015.ResultsSixteen patients required cutting balloon endopyelotomy to achieve complete resolution of narrowing of the waist observed during high-pressure balloon dilatation of the PUJ. Mean operative time was 35 ± 21 min (mean ± SD) and hospital stay was <24 h in all patients. Complete resolution of the narrowing at the PUJ under fluoroscopy was achieved in all cases, with no perioperative complications. One patient presented with urinary tract infection, postoperatively (Clavien grade II). Preoperatively, all cases had grade IV SFU hydronephrosis with parenchymal thinning. During follow-up, resolution of the hydronephrosis was observed in 11 patients (grade I SFU). In four infants, there was an improvement of the hydronephrosis (grade II SFU) and the renogram curve. In one case, an open pyeloplasty was required due to persistent hydronephrosis and obstructive curve.ConclusionWe believe that endopyelotomy with cutting balloon could be a valid and safe option in minimally invasive management of UPJO in infants.

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Section: Discussioncontrasting

confidence: 56%

Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants

et al. 2016

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“…Specific roles and case selection for robot-assisted techniques are yet to be clearly defined. This is reflected in the evolving characteristic of literature that in recent years has included series of increasingly complex operations such as revision surgery (17), simultaneous bilateral procedures (18) and procedures on younger patients (19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Global trends in paediatric robot-assisted urological surgery: a bibliometric and Progressive Scholarly Acceptance analysis

et al. 2017

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The inaugural robot-assisted urological procedure in a child was performed in 2002. This study aims to catalogue the impact of this technology by utilizing bibliographic data as a surrogate measure for global diffusion activity and to appraise the quality of evidence in this field. A systematic literature search was performed to retrieve all reported cases of paediatric robot-assisted urological surgery published between 2003 and 2016. The status of scientific community acceptance was determined using a newly developed analysis model named progressive scholarly acceptance. A total of 151 publications were identified that reported 3688 procedures in 3372 patients. The most reported procedures were pyeloplasty (n = 1923) and ureteral reimplantation (n = 1120). There were 16 countries and 48 institutions represented in the literature. On average, the total case volume reported in the literature more than doubled each year (mean value increase 236.6% per annum). The level of evidence for original studies remains limited to case reports, case series and retrospective comparative studies. Progressive Scholarly Acceptance charts indicate that robot-assisted techniques for pyeloplasty or ureteral reimplantation are yet to be accepted by the scientific community. Global adoption trends for robotic surgery in paediatric urology have been progressive but remain low volume. Pyeloplasty and ureteral reimplantation are dominant applications. Robot-assisted techniques for these procedures are not supported by high quality evidence at present. Next-generation robots are forecast to be smaller, cheaper, more advanced and customized for paediatric patients. Ongoing critical evaluation must occur simultaneously with expected technology evolution.

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“…In patients between 1-12 years of age, it is becoming the procedure of choice and in 2015, >40% of these patients were done robotically (5). In infants (<1 year of age), the use of robotic technique remains controversial, despite multiple reports showing the feasibility and excellent outcomes comparable to open surgery (6). The primary factors that contribute to surgeons' reluctance to adopt this technique in infants is likely the decreased intraabdominal space and the 8 mm port size of the current robotic platform.…”

Section: Robotic Pyeloplastymentioning

confidence: 99%

Robotics in Pediatric Urology

Fuchs

DaJusta

2020

Int. braz j urol.

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Robotic surgery has been slow to be fully accepted in the world of pediatric urology largely because of its initial application directed towards adult use and because of the inherent high cost associated with it. However, as previously shown, it has now become the gold standard for adolescent pyeloplasty in The United States. As the adoption of robotic surgery in children has become more widespread, its use has been applied to a broader spectrum of procedures with similar success rates to standard laparoscopy. These procedures include nephrectomy, heminephrectomy, ureteral reimplantation, and ureteroureterostomy. However, it has also shown feasibility and comparable success when compared to open surgery in procedures that were previously deemed too complex to be done by standard laparoscopy. For example, bladder neck reconstruction with Mitrofanoff and Malone procedure as well as bladder augmentation. This review objective is to provide an overview of robotic surgery in pediatric urology, with a focus on the more common cases such as pyeloplasty and reimplantation as well as more complex bladder reconstruction procedures.

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Infant robotic pyeloplasty: Comparison with an open cohort

Cited by 61 publications

References 26 publications

Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants

Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants

Global trends in paediatric robot-assisted urological surgery: a bibliometric and Progressive Scholarly Acceptance analysis

Robotics in Pediatric Urology

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