Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study

Dangle, Pankaj P.; Akhavan, Ardavan; Odeleye, Melanie; Avery, Daniel I.; Lendvay, Thomas S.; Koh, Chester J.; Elder, Jack S.; Noh, Paul H.; Bansal, Danesh; Schulte, Marion; Macdonald, Jonathan; Shukla, Aseem R.; Kim, C.; Herbst, Katherine W.; Corbett, Sean T.; Kearns, James T.; Kunnavakkam, Rangesh; Gundeti, Mohan S.

doi:10.1016/j.jpurol.2015.08.015

Cited by 40 publications

(15 citation statements)

References 18 publications

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“…RP was also associated with comparable or lower complication rates and comparable or higher success rates compared to OP or LP. According to a multi‐institutional study of perioperative complications after RP , complication rates after RP (13.8%) were consistent with previously reported complication rates for pediatric LP (0%–17.9%) and pediatric RP (1.1%–22.8%) . As in previous reviews, the major limitation with the present review was the lack of randomized controlled trials in the literature.…”

Section: Distinctive Robotic Surgeries For Pediatric Patientssupporting

confidence: 90%

“…A multi‐institutional study of complications after pediatric RALS revealed that RALUR procedures, especially bilateral cases, have relatively high complication rates (30.6%) , but a more recent study found low complication rates that were comparable to those after open surgery . Although it remains unclear whether the robotic approach reduces the morbidity associated with a ureteral reimplant , the advantages of RALUR have been demonstrated.…”

Section: Distinctive Robotic Surgeries For Pediatric Patientsmentioning

confidence: 99%

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Robotic surgery in pediatric urology: Current status

Mizuno

Kojima

Nishio

et al. 2018

Asian J Endoscop Surgery

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Robot‐assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3‐D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.

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Section: Distinctive Robotic Surgeries For Pediatric Patientssupporting

confidence: 90%

Section: Distinctive Robotic Surgeries For Pediatric Patientsmentioning

confidence: 99%

Robotic surgery in pediatric urology: Current status

Mizuno

Kojima

Nishio

et al. 2018

Asian J Endoscop Surgery

View full text Add to dashboard Cite

show abstract

“…With regard to the lower tract procedures, a recent metaanalysis comparing the open approach and RAL for ureteric reimplantation, concluded that ureteric reimplantation carried out via RAL should be considered an effective treatment for paediatric vesicoureteral reflux [18]. Furthermore, we have published multi-institutional studies in recent years showing the safety of this procedure [7,8]. With regard to augmentation cystoplasty, Schlomer et al [19] studied a cohort of 2831 patients, and found that 40.1% experienced a high-grade complication or underwent a subsequent procedure within 1 year.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Owing to the limitations of a retrospective database study, we were unable to determine the conversion rates to the open approach. To our knowledge, conversion rates for pediatric RALP range from zero to 1.4% from multi-institution studies to zero in single center studies [19,26,27]. Complications managed on an outpatient basis or possibly at hospitals not within the UHC database were not captured.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions

Chan

Durbin‐Johnson

Sturm

et al. 2017

Journal of Pediatric Urology

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Summary Introduction Patient age and hospital volume have been shown to affect perioperative outcomes after pediatric pyeloplasty. However, to date, there are few multicenter studies that focus on outcomes at teaching hospitals, where many of the operations are performed. Objective The goal was to determine if surgical approach, age, case volume, or other factors influence perioperative outcomes in a large contemporary cohort. Study design Using the clinical database/resource manager (CDB/RM) of the University Health-System Consortium (UHC), children who underwent open, laparoscopic, or robotic pyeloplasty from 2011 to 2014 were identified at 102 academic institutions. Surgery type, age, race, gender, insurance type, geographic region, comorbidities, surgeon volume, and hospital volume were measured. Multivariable mixed-effects logistic regression analysis was used to analyze independent variables associated with complication rates, length of stay (LOS), readmission rates, and ICU admission. Results A total of 2,219 patients were identified. Complication rates were 2.1%, 2.2%, and 3% after open, laparoscopic, and robotic pyeloplasty, respectively. Approximately 12% of patients had underlying comorbidities. Comorbidities were associated with 3.1 times increased odds for complication (p = 0.001) and a 35% longer length of stay (p < 0.001). Age, gender, insurance type, and hospital volume had no effect on complication rates. A trend was seen towards a lower rate of complications with higher surgeon volume (p = 0.08). The mean LOS was 2.0 days in the open pyeloplasty group, 2.4 days in the laparoscopic group and 1.8 days in the robotic group. Patients who underwent robotic surgery had an estimated LOS 11% shorter than those after open surgery (p = 0.03) (table). Patients aged 5 years and under who had robotic surgery had an estimated LOS 14% shorter than those after open surgery (p = 0.06). ICU admission and hospital readmission were not associated with any variables. Discussion The study is limited by the accuracy of the data submitted by the hospitals and is subject to coding error. Complication rates remain low in all three approaches, validating their safety. Patients, including younger patients, had shorter lengths of stay after robotic surgery. The statistically significant differences between approaches were small so clinically there may not be a difference. Conclusions This large multicenter analysis demonstrates that patient comorbidity had the greatest impact upon complication rates and length of stay. Previous work showed that the benefits of laparoscopy were limited to older children. However, this large multicenter study suggests that these benefits now extend to young children with the application of robotics.

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Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study

Cited by 40 publications

References 18 publications

Robotic surgery in pediatric urology: Current status

Robotic surgery in pediatric urology: Current status

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

Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions

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