Outcomes in Pediatric Robot-Assisted Laparoscopic Heminephrectomy Compared with Contemporary Open and Laparoscopic Series

Abstract

Purpose: To compare our renal and clinical outcomes for robot-assisted laparoscopic heminephrectomy (RAL-HN) in the pediatric population with duplicated systems with those of current contemporary open and laparoscopic series. Patients and Methods: Sixteen children underwent RAL-HN from 2009 to 2014. Data were collected via retrospective chart review including demographics, preoperative and postoperative imaging, operative time, estimated blood loss (EBL), length of stay (LOS), complications, and renal outcomes. Results: Mean age at surgery was 37.5 -49.2 months. Mean operative time was 135 -36 minutes with an EBL of 10 -5 mL. Mean LOS was 2 -0.8 days, and no major perioperative complications were observed. Mean follow-up was 22.1 -17.2 months. Two patients needed secondary ureterectomy for recurrent urinary tract infection in the setting of a refluxing ureteral stump. One of these patients also underwent a ureteral reimplantation of the ipsilateral normal ureter. No patients lost their remaining healthy moiety. Asymptomatic cyst formation was seen in four (25%) patients, and self-limited postoperative urinoma was seen in 2 (13%) patients. Postoperative perinephric abscess did not develop in any patient. Mean change in renal function based on nuclear renography of the duplex kidney was -2.7% -4.6%. Conclusions: Compared with previously published literature evaluating open and laparoscopic heminephrectomy, RAL-HN provides comparable outcomes in regard to complication rate and renal function of the remnant moiety.

Partial nephrectomy for small children: Robot‐assisted versus open surgery

“…Table compares the results of prior literature regarding RAHN versus open surgery and standard laparoscopy for small children . Theoretically, laparoscopy predicts a reduced hospital stay.…”

“…RAHN produces similar trends and has a low complication rate as well. This surgical approach has been described for duplex kidney previously, albeit for older pediatric patients . Olsen et al .…”

“…The present data suggest that in comparison with the open approach, RAHN is technically feasible with similar renal outcomes, lower hospital stay and less postoperative pain, even in lower-weight patients. Table 3 compares the results of prior literature regarding RAHN [13][14][15]18 versus open surgery 19,20 and standard laparoscopy for small children. [21][22][23][24][25] Theoretically, laparoscopy predicts a reduced hospital stay.…”

“…12 There have been few publications of studies describing RAHN, and none focus on how to carry out this type of surgery with small children. [13][14][15] We hypothesized that RAHN is safe and feasible in children weighing <15 kg, and would produce similar outcomes and complications as compared with the outcomes of open heminephrectomy.…”

Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis

“…Traditionally, these were open operations [8], however as experience with minimally invasive approaches has improved, many are now performed laparoscopically [9-11], or robotically [12]. Post-operatively, most patients recover well, and the length of stay in hospital is modest.…”