Lessons learned from a single‐surgeon series of paediatric robot‐assisted laparoscopic urological procedures: predictors of high‐grade postoperative complications

Abstract

Objectives To describe postoperative complications after robot‐assisted laparoscopic urological surgery in children, and identify potential predictors of these complications by analysing the outcomes of a large‐volume single‐surgeon experience. Patients and Methods We reviewed our institutional database to identify all robot‐assisted laparoscopy (RAL) cases performed between December 2007 and December 2017. Patients were grouped into three cohorts based on the anatomical location of the procedure: upper urinary tract (kidney and renal pelvis); lower urinary tract (ureter); and lower urinary tract reconstruction with bowel (bladder reconstruction). A descriptive analysis of baseline characteristics, intra‐operative variables and postoperative outcomes was carried out. All complications were graded using the Clavien–Dindo scale, and grouped based on type and time of occurrence (<30, 30–90, >90 days). Multivariable logistic regression analysis was performed to identify predictors of high‐grade complications (Clavien–Dindo grade ≥ III). We also measured complication rates based on year of surgery and surgical caseload. Results Our database included a total of 326 patients, of whom 57% (n = 186) underwent upper urinary tract procedures, 30% (n = 97) ureteric procedures, and 13% bladder reconstruction. The median follow‐up for each procedure was 13, 11 and 57 months, respectively. Of the total, 10 cases were converted to an open approach and excluded from further analysis. The most common types of complication in all groups were infections (urinary tract infections) and urinary complications (urine leaks and urolithiasis). Bladder reconstructive procedures, which require the use of bowel, presented the highest rate of high‐grade complications (32%). Length of hospital stay (LOS; odds ratio [OR] 1.33, confidence interval [CI] 1.16–1.53), estimated blood loss (EBL) in surgery (OR 1.01, CI 1.002–1.019) and operating time (OR 1.004, CI 1.002–1.006) were all associated with increased odds of high‐grade complications on multivariate analysis (P < 0.05). Conclusions In this single‐surgeon series, we have described the most commonly encountered complications after RAL in paediatric urology, finding rates similar to the complication rates reported in the current literature on other surgical approaches. In addition, LOS, operating time and EBL, which are probable surrogates of case complexity, were associated with increased odds of high‐grade complications.

Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study

“…Large cohort studies in urology report a complication rate ranging from 3% to 19%. As in our study, the most frequently reported postoperative complications were urinary tract infections 16,36–38 . Compared with the open approach, however, robotic surgery may decrease the number of postoperative infections 37 .…”

“…As in our study, the most frequently reported postoperative complications were urinary tract infections. 16,[36][37][38] Compared with the open approach, however, robotic surgery may decrease the number of postoperative infections. 37 ENT surgery showed the highest rate of complications in our study, although they were minor.…”

Nursing Intervention Countermeasures of Robot-Assisted Laparoscopic Urological Surgery Complications

“…In recent years, with the development of science and technology, minimally invasive surgery has become one of the mainstream directions in the development of urology, in which robotic surgery, as a new minimally invasive surgical method, is gradually being applied in the field of surgery [ 1 ]. The da Vinci surgical system (DVSS) is widely used in clinical practice.…”