Computer assisted pyeloplasty in children: the retroperitoneal approach

We describe the first series of computer assisted retroperitoneoscopic pyeloplasty in children using the Da Vinci Surgical System (Intuitive Surgical, Inc., Mountainview, California) with regard to setup, method, operation time, complications and preliminary outcome. The small space in the retroperitoneum of children and larger instruments of the computer assisted surgical system make modification of the retroperitoneal access necessary.

In 13 children with a median age of 6.7 years (range 3.5 to 16.2) and ureteropelvic junction obstruction 15 pyeloplasties were performed with the Da Vinci Surgical System. With the patient in a lateral semiprone position the retroperitoneal space was developed by blunt and balloon dissection. Three ports were placed for the computer assisted system and 1 for assistance. Pyeloplasty was performed with the mounted system placed behind the patient.

The procedures were completed in all patients with the computer assisted system. Median operative time was 173 minutes (range 76 to 215) and there were no perioperative complications. Median postoperative hospital stay was 2 days (range 1 to 3). Two patients had postoperative complications related to the Double-J catheter (Cook Urological Inc., Spencer, Indiana). In 1 patient the catheter was displaced with its lower end in the distal ureter, and the other patient was rehospitalized with occlusion of the catheter and treated with nephrostomy for a few days. All patients had a satisfying outcome during the preliminary followup period of 1 to 7 months.

In this the first series of computer-assisted retroperitoneal pyeloplasty in children the method seems feasible with shorter operative time and similar complications as in standard retroperitoneoscopic procedures but easier handling of the instruments and shorter training for the surgeon. The costs for the system are still high and only longer followup will reveal whether the more precise placement of sutures and the advantage of the magnified 3-dimensional view lead to at least the same results as the open procedure.