Open, Laparoscopic, and Robotic Ureteroneocystotomy for Benign and Malignant Ureteral Lesions: A Comparison of Over 100 Minimally Invasive Cases

Elsamra, Sammy; Theckumparampil, Nithin; Garden, Bradley; Alom, Manaf; Waingankar, Nikhil; Leavitt, David; Kreshover, Jessica; Schwartz, Michael; Kavoussi, Louis R.; Richstone, Lee

doi:10.1089/end.2014.0243

Cited by 36 publications

(32 citation statements)

References 16 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MIS has been associated with comparable-or-better lengths of stay (LOS), recovery times, and postoperative morbidity and mortality in prior literature from adult and pediatric urologic case-series, and other surgical subspecialties [7–9,14,23]. Indeed, LOS and recovery time in particular may factor prominently in our observed incidence of pulmonary complications, given known risks for atelectasis, pneumonia, and upper-respiratory tract infections associated with prolonged hospitalization [24].…”

Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications

Tejwani

Young

Wang

et al. 2017

Journal of Pediatric Urology

View full text Add to dashboard Cite

Summary Objective Minimally invasive surgery (MIS) techniques are anecdotally reported to be increasingly used, but little objective data supports this. Our objective was to assess trends in MIS utilization across various procedures in pediatric urology and to compare postoperative complication rates between MIS and open procedures. Methods We analyzed the 1998–2012 Nationwide Inpatient Sample. We identified children (<18 years old) undergoing open and MIS inpatient procedures and any in-hospital postoperative complications that occurred during that postoperative hospitalization. We utilized propensity score matching and multivariable logistic regression to adjust for confounding factors. Results We identified 163,838 weighted encounters in the “overall cohort,” 70,273 of which were at centers performing more than five MIS procedures over the years studied. Use of MIS techniques increased significantly over time for several procedures, most prominently for nephrectomy (Figure). The overall rate of complications was lower in patients undergoing MIS compared with open surgery (6% vs. 11%, p<0.001). Specialized centers had a significantly lower overall rate of complications than unspecialized centers (9% vs. 12%, p<0.001). Within specialized centers, MIS had lower complication rates than open procedures (7% vs. 9%, p<0.001); this finding was consistent even after adjusting for other factors (OR 0.71, p=0.02). Discussion Limitations include that these data may not be generalizable to encounters not in the sample pool. As a large, retrospective, administrative database, NIS may be affected by miscoding bias – rendering our analysis sensitive to the accuracy of procedure coding in NIS. Although the accuracy level of NIS is high for an administrative database, it is possible at least some portion of our cohort may be incorrectly coded. Further, the NSQIP complications we identified may represent associated comorbidities and not true postoperative complications, as NIS does not provide temporal relationships between different diagnosis codes. Despite these limitations, we note that the NIS database is rigorously monitored and audited for coding accuracy and, therefore, represents a reasonably reliable panorama of the characteristics of an inpatient surgical cohort. However, it is important to note that the choice of operative modality is, undoubtedly, multifactorial and patient/setting-specific. Conclusions There is increasing use of MIS for pediatric urology procedures, although utilization rates vary among procedures. MIS was associated with a lower postoperative complication rate than for open procedures. Higher-volume MIS centers have a lower complication rate than lower-volume centers.

show abstract

Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications

Tejwani

Young

Wang

et al. 2017

Journal of Pediatric Urology

View full text Add to dashboard Cite

show abstract

“…A total of 44 articles was screened. After removing repeated studies and applying inclusion and exclusion criteria, 12 articles were included into the systematic review [ 2 , 4 – 7 , 16 – 22 ]. Figure 1 shows the flow diagram.…”

Section: Resultsmentioning

confidence: 99%

“…From them, eight were case series [ 2 , 4 , 5 , 16 – 20 ] and four had comparative study design comparing RAL and open approaches (two articles) [ 7 , 21 ], two different RAL techniques (one article) [ 6 ], as well as RAL, laparoscopic and open surgeries (one article) [ 22 ]. Review and analysis of the last article data were performed only in RAL and open groups [ 22 ]. Overall, data comprised 245 RAL and 76 open ureteral surgery cases (85 laparoscopic cases were omitted).…”

Section: Resultsmentioning

confidence: 99%

Robot-Assisted Laparoscopic Ureteral Reconstruction: а systematic review of literature

Колонтарев¹,

Kasyan²,

Pushkar³

2018

CEJU

View full text Add to dashboard Cite

IntroductionTo review the literature, as well as to analyze and compare available data on robot-assisted laparoscopic (RAL) surgery versus open surgery, carried out in ureteral reconstructions in terms of different surgical characteristics.Materials and methodsEligible studies, published between 1997 and July 2016, were retrieved through MEDLINE by applying predetermined inclusion and exclusion criteria with the English language restriction. Publications on RAL surgeries, carried out in different ureteral reconstructions and of any study design, including case series and comparative studies, were included. The study was performed in accordance with the PRISMA statement.ResultsA total of 12 retrospective studies (case series and comparative studies) met the systematic review selection criteria involving 245 RAL and 76 open ureteral surgery cases. Main indications for ureter reconstruction were strictures, tumors and injuries. The individual results of comparative studies revealed that the EBL was statistically significantly lower for RAL than for open surgery. As for operation time, length of hospital stay and follow-up time, the data was contradictory. The rate of recurrent stricture in RAL and open groups was similar: -9.0%. The meta-analysis of three comparative studies confirmed that patients lose statistically significantly less blood in RAL, compared to open surgery.ConclusionsThe analysis of limited data available shows that robot-assisted laparoscopic ureteral reconstruction is a safe and effective minimally invasive technique with high cure rates similar to those of the conventional open approach and, with favorable safety profile. Future well-designed randomized controlled trials are required to strengthen our findings.

show abstract

“…As such, our reported results may not be generalizable to encounters not in the sample pool. However, NIS does provide meticulous tracking of discharge and hospital weights to minimize the risk of sampling bias [32]. Additionally, NIS is a large retrospective administrative database that might be affected by miscoding bias.…”

Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Wang

Tejwani

Cannon

et al. 2016

Journal of Pediatric Urology

View full text Add to dashboard Cite

Summary Introduction Open ureteroneocystostomy (UNC) is the gold standard for surgical correction of vesicoureteral reflux (VUR). Beyond single-center reports, there are few published data on outcomes of minimally invasive (MIS) UNC. Our objective was to compare postoperative outcomes of open and MIS UNC using national, population-level data. Method We reviewed the 1998–2012 Nationwide Inpatient Sample to identify pediatric (≤18 years) VUR patients who underwent either open or MIS UNC. Demographics, National Surgical Quality Improvement Program (NSQIP) complications, length of stay (LOS), and cost data were extracted. Statistical analysis was performed using weighted, hierarchical multivariate logistic regression (complications) and negative binomial regression (LOS, cost). Results We identified 780 MIS and 75,976 open UNC admissions. Compared with patients undergoing open UNC, patients who underwent MIS UNC were likely to be older (6.2 versus 4.8 years, p<0.001), publically insured (43 versus 26%, p<0.001), and treated in recent years (90 versus 46% after 2005, p<0.001). MIS admissions were associated with a significantly shorter length of stay (1.0 versus 1.8 days, p<0.001) and higher cost ($9,230 versus $6,304, p=0.002). After adjusting for patient-level confounders (age, gender, insurance, treatment year, and comorbidity), and hospital-level factors (region, bedsize, and teaching status), MIS UNC was associated with a significantly higher rate of postoperative urinary complications such as UTIs, urinary retention, and renal injury (OR 3.1, p=0.02), shorter LOS (RR 0.8, p=0.02), and higher cost (RR 1.4, p=0.008). Discussion Strengths of this study are its large cohort size, long time horizon, national estimation, and cost data. Most prior studies are case-series limited to the size of the institutional cohort. Our analysis of 76,756 operative encounters revealed that open UNC continues to be performed at far greater frequency than MIS UNC, outpacing the latter modality by nearly 100:1. Children treated with MIS UNC had three times greater odds of developing postoperative urinary complications, and MIS UNC patients incurred average costs per admission that were nearly 1.5 times higher than those of children who underwent open UNC. These children were also likely to be older, publically insured, and treated in more recent years. On the other hand, patients treated with MIS UNC required substantially shorter postoperative hospitalization, with an average LOS roughly half that of open UNC cases. Limitations include the retrospective nature of the administrative database, lack of detailed patient-level data, and no available long-term postoperative outcomes. Compared with open surgery, MIS UNC was associated with shorter LOS but higher costs and possibly higher urinary complication rates.

show abstract

Open, Laparoscopic, and Robotic Ureteroneocystotomy for Benign and Malignant Ureteral Lesions: A Comparison of Over 100 Minimally Invasive Cases

Abstract: RAL or LAP UNC is feasible, safe, and comparable to the open technique with some perioperative benefit in EBL, LOS, and stent duration.

Cited by 36 publications

References 16 publications

Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications

Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications

Robot-Assisted Laparoscopic Ureteral Reconstruction: а systematic review of literature

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Contact Info

Product

Resources

About