453 ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY MULTI-INSTITUTIONAL EXPERIENCE IN INFANTS (2012)

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2012453 ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY MULTI-INSTITUTIONAL EXPERIENCE IN INFANTS Daniel I. Avery, Thomas S. Lendvay, Katherine W. Herbst, Matthew C. Steele, Sean T. Corbett, C. D. Anthony Herndon, and Christina Kim Daniel I. AveryDaniel I. Avery Seattle, WA More articles by this author , Thomas S. LendvayThomas S. Lendvay Seattle, WA More articles by this author , Katherine W. HerbstKatherine W. Herbst Hartford, CT More articles by this author , Matthew C. SteeleMatthew C. Steele Charlottesville, VA More articles by this author , Sean T. CorbettSean T. Corbett Charlottesville, VA More articles by this author , C. D. Anthony HerndonC. D. Anthony Herndon Charlottesville, VA More articles by this author , and Christina KimChristina Kim Hartford, CT More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.521AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among pediatric urologists. Over 300 have been described in the literature within pediatric series, but only one small single-center study evaluated the role of RALP in infants alone. We surveyed the experiences of multiple centers on the safety and efficacy of RALP in the infant population. METHODS We reviewed the records of all RALP operations on patients less than 1 year of age conducted by 4 surgeons at 3 different institutions between April 2006 and August 2011. Pre-, peri-, and post-operative data were collected and analyzed. RESULTS Forty-one infants with 43 ureteropelvic junction obstructions (UPJO) underwent RALP. Thirty-eight patients (92.7%) were diagnosed after prenatal ultrasound demonstrated hydronephrosis. The median age at surgery was 7.0 months (1-12) and the median weight was 8.2 kg (5.7-12.6). All surgeries reported minimal blood loss. One procedure was converted to pure laparoscopy due to robotic malfunction -the only operative complication in the group. Median surgical time was 231 minutes (150-345) with a slight downward trend over time approaching significance (p=0.063). Ureteral stents were placed in all procedures. Removal required a second anesthetic. One patient had an external drain. Forty-two of 43 patients had a Foley catheter which was removed prior to discharge. Thirty-four patients (81%) were discharged on post-operative day 1 (1-6). There were 3 post-operative complications: 1 ileus, 1 UTI, 1 port site hernia. Follow-up data is available for 36 patients representing 38 kidneys (3 await post-operative imaging and 2 were lost to follow-up). Median follow-up time was 19 months (1-53). Of the 38 repairs with post-operative imaging, 37 (97.3%) showed improvement or resolution of the hydronephrosis on renal ultrasound. There were 2 failures. One had worse drainage on renal scan 10 months after the surgery (despite improved ultrasound post-operatively). After balloon dilation he is currently doing well. The other had worsened hydronephrosis post-operatively on ultrasound; a renal scan showed that he had developed complete UPJO. He had a successful repeat RALP. CONCLUSIONS RALP has become a viable surgical approach for the correction of pediatric UPJO. We show that the use of robotic assistance in infant pyeloplasty is not only safe but effective, with success rates comparable to open and laparoscopic series. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e185 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel I. Avery Seattle, WA More articles by this author Thomas S. Lendvay Seattle, WA More articles by this author Katherine W. Herbst Hartford, CT More articles by this author Matthew C. Steele Charlottesville, VA More articles by this author Sean T. Corbett Charlottesville, VA More articles by this author C. D. Anthony Herndon Charlottesville, VA More articles by this author Christina Kim Hartford, CT More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...