Robot‑Assisted Laparoscopic Extra-Vesical Ureteral Reimplantation (Ralur/Revur) for Pediatric Vesicoureteral Reflux: A Systematic Review of Literature

Esposito, Ciro; Castagnetti, Marco; Autorino, Giuseppe; Coppola, Vincenzo; Cerulo, Mariapina; Esposito, Giulia; Escolino, Maria

doi:10.1016/j.urology.2021.06.043

Cited by 21 publications

(6 citation statements)

References 40 publications

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“…Current gold standard surgical option for pediatric VUR is open trans-hiatal ureteral reimplantation according to Cohen with very high success rate (98%) [ 2 ]. Endoscopic injection (EI), laparoscopic extravesical ureteral reimplantation (LEVUR) and robot-assisted laparoscopic ureteral reimplantation (RALUR) are alternatives to open approach [ 3 , 4 ]. One randomized controlled trial (RCT 2b-C) [ 5 ] comparing Cohen’s reimplantation vs EI in children aged over 1 year reported short- and long-term outcomes similar for VUR grades II, III, and IV.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature

et al. 2023

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In the last 20 years, endoscopic injection (EI) has affirmed as a valid alternative to open surgery for management of pediatric vesicoureteral reflux (VUR). This study aimed to investigate and discuss some debated aspects such as indications, bulking agents and comparison, techniques of injection and comparison, predictive factors of success, use in specific situations. EI is minimally invasive, well accepted by patients and families, with short learning curve and low-morbidity profile. It provides reflux resolution rates approaching those of open reimplantation, ranging from 69 to 100%. Obviously, the success rate may be influenced by several factors. Recently, it is adopted as first-line therapy also in high grade reflux or complex anatomy such as duplex, bladder diverticula, ectopic ureters. The two most used materials for injection are Deflux and Vantris. The first is absorbable, easier to inject, has lower risk of obstruction, but can lose efficacy over time. The second is non-absorbable, more difficult to inject, has higher risk of obstruction, but it is potentially more durable. The two main techniques are STING and HIT. To date, the ideal material and technique of injection has not yet clearly established, but the choice remains dependent on surgeon’s preference and experience.

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Section: Resultsmentioning

confidence: 99%

Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature

et al. 2023

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“…A systematic review exploring RAS for UR in 1362 children with an average age of 5.4 years was recently published [ 19 ]. The study found rates of 92% success, 1.5% intraoperative complications, 10.7% postoperative complications (8.2%: Clavien I-II, 2.5%: Clavien III), and 3.9% reinterventions.…”

Section: Resultsmentioning

confidence: 99%

Robotically Assisted Surgery in Children—A Perspective

Krebs

Schnorr

Heye³

et al. 2022

Children

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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.

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“…The first pediatric patients undergoing surgery using a robotic approach date back to 2002 (10,11) . In the last 20 years, an increasing number of studies have been published, demonstrating the increase in the use of robotic technology among the pediatric age group, from 3 publications in 2002 to 43 in 2021, mainly in the urological field (20,21) . The main drawbacks reported by Denning et al (22) of the use of the robotic system in pediatric patients are the lack of availability of 5mm instruments in the Xi model, and the fact the size of the patient limits the working field and the possibility of using the fourth robotic arm.…”

Section: Discussionmentioning

confidence: 99%

Implementing a pediatric robotic surgery program: future perspectives

Beauregard¹,

García²,

Amillo³

et al. 2022

Cir Pediatr

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The minimally invasive approach using robotic technology is fully incorporated in the treatment of adult pathologies.The first international pediatric studies with a robotic approach date from 2002, and in Spain, from 2009. We present the implementation of a Pediatric Robotic Surgery program in our setting. Materials and methods.A proposal for the application of robotic technology in pediatrics was developed, and after the acquisition of a Da Vinci Xi system at our center, a program was initiated under the guidance of a pediatric surgeon experienced in this approach.Results. 32 patients with a median age of 12 years (7 months-17 years) have been operated on since January 2019. 56% of the procedures were abdominal. 3 thoracic approaches and 11 urologic procedures were carried out. 1 conversion to open surgery was performed during a fundoplication. The median combined duration of abdominal and thoracic approaches was 155 minutes (70-380 minutes). There were no anesthetic or hemodynamic complications. The postoperative period in the cases in which the procedure was completed was uneventful, and patients were discharged after a median of 2 days (1-16 days). Conclusion.The main advantage of robotic procedures is the symmetrical movement in line with the surgeon's hands, which makes the learning curve shorter. In our experience, the robotic approach has allowed for greater precision in the surgical technique, favoring the patient's recovery.

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Robot‑Assisted Laparoscopic Extra-Vesical Ureteral Reimplantation (Ralur/Revur) for Pediatric Vesicoureteral Reflux: A Systematic Review of Literature

Cited by 21 publications

References 40 publications

Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature

Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature

Robotically Assisted Surgery in Children—A Perspective

Implementing a pediatric robotic surgery program: future perspectives

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