Prospective Long-term Analysis of Nerve-sparing Extravesical Robotic-assisted Laparoscopic Ureteral Reimplantation

Kasturi, Sanjay; Sehgal, Shelly; Christman, Matthew; Lambert, Sarah M.; Casale, Pasquale

doi:10.1016/j.urology.2011.10.052

Cited by 91 publications

(34 citation statements)

References 19 publications

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“…However, these benefits come at some expense, both clinically and financially. Several small cohort studies have mirrored our findings of increased incidences of postoperative urinary complications, often including urinary retention, urine leakage, and voiding dysfunction [21,24,27,28]. The reasons for this phenomenon are currently unknown and warrant additional future study, but may speculatively stem from nerve injury through the extravesical approach, lack of sufficient tactile feedback, and difficulty with fine instrument movements.…”

Section: Discussionmentioning

confidence: 52%

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Wang

Tejwani

Cannon

et al. 2016

Journal of Pediatric Urology

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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.

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Section: Discussionmentioning

confidence: 52%

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Wang

Tejwani

Cannon

et al. 2016

Journal of Pediatric Urology

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“…[35] The improved visualization can avoid injury to the neurovascular plexus, which is situated immediately lateral to the ureteral hiatus, and may decrease the incidence of postoperative urinary retention. More recently, Kasturi et al [36] reviewed 150 patients who underwent bilateral robotic-assisted extravesical ureteral reimplantation for VUR with a 99.3% success rate and minimal morbidity, reaffirming the safety and efficacy of this procedure.…”

Section: Extravesical Approachmentioning

confidence: 92%

Robotic-assisted laparoscopic surgery in pediatric urology: an update

Kojima¹,

Khurgin²,

Casale³

2012

Turkish Journal of Urology

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Laparoscopic procedures for urological diseases in children, such as nephrectomy, pyeloplasty and orchiopexy, have proven to be safe and effective with outcomes comparable to open procedures. The main drawback has been the relatively steep learning curve for this procedure that is associated with technical difficulties such as suturing and anastomosis. More recently, robotic-assisted laparoscopic surgery (RAS) has gained enormous popularity in adult urology and is increasingly being adopted around the world; however, few pediatric urology series have been reported. RAS has several advantages over conventional laparoscopic surgery, mainly the simplification and precision of exposure and suturing. The robotic arms move in real time with an increased degree of freedom and a magnified, 3-dimensional view. These features render RAS ideal for complex reconstructive surgery in a pediatric urological population. This review discusses the role of RAS in pediatric urology, provides technical aspects of RAS and offers a critical summary of current knowledge on its indications and outcomes. Almost all operations that are classically performed as open or conventional laparoscopic reconstructive surgeries for children with urological anomalies could be replaced by RAS and this procedure may be established as an alternative minimally invasive surgery in the future.Key words: Laparoscopy; minimally invasive surgery; pediatrics; robotics; urinary tract reconstruction; urology. ÖZETÇocuklarda nefrektomi, piyeloplasti ve orşiopeksi gibi ürolojik hastalıklar için laparoskopik prosedürlerin, açık prosedürlerle kıyaslanabilir sonuçlar ile birlikte, güvenli ve etkili olduğu kanıtlanmıştır. Bu prosedür-lerin, sütür atma ve anastamoz gibi teknik zorluklarla ilişkili göreceli dik öğrenme eğrisi olması başlıca dezavantaj olmaktadır. Son zamanlarda, robot yardımlı laparoskopik cerrahi (RAS) erişkin ürolojisinde olağanüstü bir popülerlik kazanmıştır ve bütün dünyada giderek artan bir şekilde kabul görmektedir; buna karşın, bir kaç pediatrik üroloji serisi yayınlanmıştır. RAS konvansiyonel laparoskopik cerrahiye kıyasla bir kaç avantaja sahiptir; bunların başlıcaları pozlama ve sütur atmanın kolaylığı ve hassasiyetidir. Robot kollar artmış bir serbestlik derecesinde ve büyütülmüş 3 boyutlu bir bakış açısıyla gerçek zamanlı olarak hareket etmektedir. Bu özellikler RAS'ı pediatrik ürolojik populasyonda kompleks rekonstrüktif cerrahi için ideal yapmaktadır. Bu derleme pediatrik ürolojide RAS'ın rolünü tartışmakta, RAS'ın teknik yönlerini bildirmekte ve endikasyonları ve sonuçları hakkında güncel bilgilerin eleştirel bir özetini sunmaktadır. Ürolojik anomalisi olan çocuklar için açık veya konvansiyonel laparoskopik rekonstrüktif cerrahi şeklinde klasik olarak yapılan hemen hemen tüm operasyonların yerine RAS yapılabilir ve bu prosedür gelecekte alternatif bir minimal invaziv cerrahi olarak yerleşebilir.

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“…While initial success rates were low,[19] more recent reports indicate success rates of 97-99%,[2021] when compared with open surgery, robotic ureteral reimplantation was associated with shorter duration of urethral catheterization, fewer bladder spasms, and shorter hospitalizations,[2223] there is decreased incidence of postoperative urinary retention with this approach. [24]…”

Section: Procedural Applications and Outcomesmentioning

confidence: 99%

Pediatric robotic urologic surgery-2014

Kearns

Gundeti

2014

J Indian Assoc Pediatr Surg

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We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide.

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Prospective Long-term Analysis of Nerve-sparing Extravesical Robotic-assisted Laparoscopic Ureteral Reimplantation

Cited by 91 publications

References 19 publications

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Open versus minimally invasive ureteroneocystostomy: A population-level analysis

Robotic-assisted laparoscopic surgery in pediatric urology: an update

Pediatric robotic urologic surgery-2014

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