Robot-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection in an Adolescent Population

Cost, Nicholas G.; DaJusta, Daniel; Granberg, Candace F.; Cooksey, Raven; Laborde, Carrie; Wickiser, Jonathan E.; Gargollo, Patricio C.

doi:10.1089/end.2011.0214

Cited by 41 publications

(30 citation statements)

References 21 publications

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“…Our median operative time of 540 min was substantial compared with the adult literature (150–329 min) [24]; however, we performed bilateral re-sections in both cases. In addition, Cost et al reported a similar OT (527 min) for a post-chemotherapy, bilateral RPLND in a 15-year-old male [11]. In regards to ejaculatory function, one patient has regained antegrade ejaculation, whereas the other has not.…”

Section: Discussionmentioning

confidence: 95%

“…In the current literature, there are only four case reports of robotic techniques for cancers with pathology similar to adults in adolescent patients, namely renal cell carcinoma [10] and two non-seminomatous germ cell tumors [11], and one report of robotic nephrectomy being used safely for Wilms’ tumor in an adolescent patient [12]. The reasons for this are multifactorial: 1) genitourinary (GU) malignancies in pediatric patients are rare, making it difficult to amass case volume, 2) when they do occur, many are too large or complex for minimally invasive techniques, 3) the current management strategies for pediatric GU cancers are largely successful, therefore the incentive to test new management approaches is limited, and 4) a majority of pediatric GU oncology cases are managed by general surgeons [8,9] who generally have lower rates of robotic utilization than urologists.…”

Section: Introductionmentioning

confidence: 99%

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Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Varda

Cho

Wagner

et al. 2018

Journal of Pediatric Urology

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Summary Background In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions. Objectives To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children’s hospital. Design We retrospectively reviewed all robotic cases performed at our institution from 2014 to 2016 for patients with a GU malignancy or a suspicious mass. The surgeries were performed by a pediatric urologist with robotic experience and a fellowship-trained MIS adult urologist specializing in oncology. Perioperative and oncologic outcomes were recorded. Results A total of eight robotic cases were performed: four partial nephrectomies (PN) with retroperitoneal lymph node dissection (LND) (OT 269–338 min, EBL 5–300 mL, LOS 3–6 days), one adrenalectomy with LND (6.4 cm mass; OT 172 min, EBL 5 mL, LOS 3 days), one nephrectomy with pericaval LND (9.8 cm mass; 234 min, EBL 25 mL, LOS 3 days), and two retroperitoneal LNDs (OT 572 and 508 min, EBL 250 and 100, LOS 3 and 4 days). Patient weights ranged from 14 to 79 kg (mean 53.4 kg). There were no major complications (Clavien 3–5). Pathology results for PN included papillary RCC (AJCC pT1aNx) and two cases of segmental cystic renal dysplasia with nephrogenic rests. Bilateral template RPLNDs yielded paratesticular rhabdomyosarcoma (43 nodes; COG low risk group II stage I) and mixed non-seminomatous germ cell tumor (74 nodes; COG stage III). The nephrectomy yielded an undifferentiated sarcoma, low grade; the adrenalectomy favorable-type ganglioneuroma. Discussion In pediatrics, urologic oncology cases are often managed with open surgery. Our series demonstrates the feasibility of using the robotic approach in carefully selected cases. In doing so, the patient benefits from a minimally invasive surgery, while the surgeon benefits from robotic surgical dexterity. We seamlessly advanced these new techniques through a step-wise collaboration between an adult urologist who routinely performs robotic oncology procedures and a pediatric urologist experienced in robotics for benign conditions. Conclusion In this small series, we safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Varda

Cho

Wagner

et al. 2018

Journal of Pediatric Urology

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“…Rather than focusing on the relatively straightforward pyeloplasties and ureteral reimplantations, complex reconstructive procedures have been described, including continent catheterizable channels,[4] robotic bladder augmentation with appendicovesicostomy robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA) or without (RALI),[5] bladder neck reconstruction,[6] and retroperitoneal lymph node dissection. [7] Large-scale series and long-term outcomes regarding these procedures have not yet been published, but early data are promising. At the very least, pediatric urologists have provided proof of principle that the most complex reconstructive surgeries can be performed robotically.…”

Section: Procedural Applications and Outcomesmentioning

confidence: 99%

“…In addition, robotic retroperitoneal lymphadenectomy for paratesticular rhabdomyosarcoma and testicular germ cell tumors have been performed with good functional and oncologic outcomes. [7]…”

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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“…Moreover, robotassisted laparoscopic retroperitoneal lymph node dissection can be safely performed. 49 …”

Section: Futurementioning

confidence: 99%

A Review on Surgical Techniques and Organ Sparing Procedures in Bladder/Prostate Rhabdomyosarcoma

et al. 2014

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The treatment outcomes in children with bladder/prostate rhabdomyosarcoma (B/P RMS) have considerably improved in the past few decades. Current protocols incorporate chemotherapy, radiotherapy, and surgery (radical or organ sparing). Using this multimodal and multidisciplinary approach, the cure rates for nonmetastatic RMS have gradually increased from 25% in the 1970s, and 70% in the 1990s, to over 80% in the 2000s. Surgery plays a role not only in the diagnosis and management of all stages of B/P RMS, but also in the urinary reconstruction and long-term follow-up. Furthermore, the tendency to avoid mutilating surgery and to preserve functional genitourinary tract has been noticeable. Authors describe the current status and future surgical treatment approaches and possibilities for patients with B/P RMS and how reconstructive urologic surgery in B/P RMS continues to evolve.

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Robot-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection in an Adolescent Population

Cited by 41 publications

References 21 publications

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Pediatric robotic urologic surgery-2014

A Review on Surgical Techniques and Organ Sparing Procedures in Bladder/Prostate Rhabdomyosarcoma

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