Primary vs redo robotic pyeloplasty: A comparison of outcomes

Mittal, Sameer; Aghababian, Aznive; Eftekharzadeh, Sahar; Dinardo, Lauren; Weaver, John; Weiß, Dana; Long, Christopher J.; Srinivasan, Arun K.; Shukla, Aseem R.

doi:10.1016/j.jpurol.2021.02.016

Cited by 19 publications

(15 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 2021, a large retrospective study compared a sample of 276 primary with 30 redo RAS pyeloplasty operations [ 18 ]. In children with an average age of 4.9 years at the time of surgery, the redo RAS had longer operating times (mean primary: 198.9 min, mean redo: 278.0 min, p -value = < 0.001) and longer hospital stays (mean primary: 1.3 days, mean redo: 2.0 days, p -value = <0.001) than the primary RAS.…”

Section: Resultsmentioning

confidence: 99%

Robotically Assisted Surgery in Children—A Perspective

Krebs

Schnorr

Heye³

et al. 2022

Children

View full text Add to dashboard Cite

The introduction of robotically assisted surgery was a milestone for minimally invasive surgery in the 21st century. Currently, there are two FDA-approved robotically assisted surgery systems for use and development in pediatrics. Specifically, tremor filtration and optimal visualization are approaches which can have enormous benefits for procedures in small bodies. Robotically assisted surgery in children might have advantages compared to laparoscopic or open approaches. This review focuses on the research literature regarding robotically assisted surgery that has been published within the past decade. A literature search was conducted to identify studies comparing robotically assisted surgery with laparoscopic and open approaches. While reported applications in urology were the most cited, three other fields (gynecology, general surgery, and “others”) were also identified. In total, 36 of the publications reviewed suggested that robotically assisted surgery was a good alternative for pediatric procedures. After several years of experience of this surgery, a strong learning curve was evident in the literature. However, some authors have highlighted limitations, such as high cost and a limited spectrum of small-sized instruments. The recent introduction of reusable 3 mm instruments to the market might help to overcome these limitations. In the future, it can be anticipated that there will be a broader range of applications for robotically assisted surgery in selected pediatric surgeries, especially as surgical skills continue to improve and further system innovations emerge.

show abstract

Section: Resultsmentioning

confidence: 99%

Robotically Assisted Surgery in Children—A Perspective

Krebs

Schnorr

Heye³

et al. 2022

Children

View full text Add to dashboard Cite

show abstract

“…11 These results are in line with a recent study by Mittal et al showing no difference in short-term outcomes or success rates between patients undergoing RALP and RALUC as a salvage treatment after an initial failed pyeloplasty. 2…”

Section: Discussionmentioning

confidence: 99%

“…While performing a redo pyeloplasty after a failed procedure is technically more complex, recent studies have shown comparable complication and outcome rates between initial repair and redo pyeloplasty. 2 Nevertheless, there are anatomical characteristics that may pose further technical challenges when performing a pyeloplasty, particularly a redo pyeloplasty, prompting surgeons to modify their pyeloplasty technique to a ureterocalicostomy.…”

mentioning

confidence: 99%

Robot-Assisted Laparoscopic Ureterocalicostomy in the Setting of Ureteropelvic Junction Obstruction: A Multi-Institutional Cohort

et al. 2022

Self Cite

View full text Add to dashboard Cite

Purpose:Recurrent ureteropelvic junction obstruction (UPJO) after failed pyeloplasty is a complex surgical dilemma. The robot-assisted laparoscopic ureterocalicostomy (RALUC) is a potential surgical approach, but widespread adoption is limited due to the perceived technical challenge of the procedure. We present a multi-institutional pediatric cohort undergoing RALUC for recurrent or complex UPJO, and hypothesize that the procedure is reproducible, safe and efficacious.Materials and Methods:A 3-center multi-institutional collaboration was initiated and medical records of children undergoing RALUC between 2012 and 2020 were retrospectively reviewed. The details on baseline demographics, perioperative characteristics and postoperative outcomes were aggregated.Results:During the study period 24 patients, 7 (29%) females and 17 (71%) males, were identified. Of the patients 21 (86%) had a history of previous pyeloplasty prior to RALUC, of whom 5 (24%) had 2 prior failed ipsilateral pyeloplasties. The reason for performing RALUC was short ureter in 3 (13%), intrarenal pelvis in 5 (21%) and extensive scarring at the ureteropelvic junction locus in 16 (67%) patients. The median age of patients at time of surgery was 5.1 years (IQR: 1.9, 14.7). Of the patients 9 (38%) had percutaneous nephrostomy prior to surgery; if percutaneous nephrostomy tubes were placed for relief of obstruction, an antegrade contrast study was done postoperatively to confirm resolution of obstruction. No 30-day Clavien-Dindo Grade III-V complications were noted. During the median followup of 16.1 months (IQR: 6, 47.5), 22 (92%) had improved symptoms and hydronephrosis with no further intervention; 2 (8%) patients underwent endoscopic interventions after RALUC and both ultimately underwent nephrectomy.Conclusions:This multi-institutional cohort demonstrates that RALUC is a safe and efficacious salvage option for failed pyeloplasty or complex anatomy with an acceptable success profile, especially in cases of extensive scarring at the UPJO or an intrarenal pelvis.

show abstract

“…At beginning, an open approach was preferentially adopted to perform UC, due to the complexity of this technique, especially in recurrent PUJO [9]. However, open approach was associated with longer operative time and higher morbidity rates due to larger surgical incisions, longer length of stay, and increased analgesic therapy [10][11][12]. These disadvantages encouraged urologists to explore less invasive surgical options.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty

et al. 2022

View full text Add to dashboard Cite

Purpose This multi-institutional study aimed to assess the outcomes of laparoscopic ureterocalicostomy (LUC) and robot-assisted laparoscopic ureterocalicostomy (RALUC) and compare them with laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO). Methods The data of 130 patients (80 boys), with median age 7.6 years and median weight 33.8 kg, receiving minimally invasive treatment of PUJO over a 6-year period, were retrospectively analyzed. Patients were grouped according to the operative approach: G1 included 15 patients, receiving LUC (n = 9) and RALUC (n = 6), and G2 included 115 patients, receiving LP (n = 30) and RALP (n = 85). Patient characteristics and operative outcomes were compared in both groups. Results The median patient age and weight were significantly higher in G1 than in G2 [p = 0.001]. The median operative time was similar in both groups (157.6 vs 150.1 min) [p = 0.66] whereas the median anastomotic time was shorter in G1 than in G2 (59.5 vs 83.1 min) [p = 0.03]. The surgical success rate was similar in both groups (100% vs 97.4%) [p = 0.33]. Post-operative complications rate was higher in G1 than in G2 (20% vs 6.1%) but all G1 complications were Clavien 2 and did not require re-intervention. Conclusion LUC/RALUC can be considered safe and effective alternative approaches to LP/RALP for PUJO repair and reported excellent outcomes as primary and salvage procedures. Robot-assisted technique was the preferred option to treat most patients with recurrent PUJO in both groups.

show abstract

Primary vs redo robotic pyeloplasty: A comparison of outcomes

Cited by 19 publications

References 21 publications

Robotically Assisted Surgery in Children—A Perspective

Robotically Assisted Surgery in Children—A Perspective

Robot-Assisted Laparoscopic Ureterocalicostomy in the Setting of Ureteropelvic Junction Obstruction: A Multi-Institutional Cohort

Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty

Contact Info

Product

Resources

About