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Robot assisted pyeloplasty in the infant-lessons learned
Alexander Kutikov1, Michael Nguyen, Thomas Guzzo
1Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Insights
Robot-assisted pyeloplasty is a safe and effective treatment for infant ureteropelvic junction obstruction. This minimally invasive approach offers successful outcomes in small patients, with good resolution of hydronephrosis.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Urology
Background:
- Ureteropelvic junction obstruction is a common congenital anomaly in infants.
- Robot-assisted pyeloplasty is an emerging technique for treating this condition.
- Challenges exist in performing minimally invasive surgery in infants due to small abdominal cavities.
Purpose of the Study:
- To present the experience and lessons learned from performing robot-assisted pyeloplasty in infants.
- To evaluate the feasibility and outcomes of this procedure in a pediatric population.
Main Methods:
- Nine infants (3-8 months old) underwent transperitoneal robot-assisted pyeloplasty for ureteropelvic junction obstruction.
- The da Vinci Surgical System was used for the Anderson-Hynes dismembered pyeloplasty.
- Outcomes included operative time, hospital stay, and resolution of obstruction via imaging.
Main Results:
- All nine infants successfully underwent robot-assisted pyeloplasty without conversion to open surgery.
- Mean operative time was 122.8 minutes, with a mean console time of 72.1 minutes.
- Seven infants (78%) showed resolution or improvement of hydronephrosis, with the remaining two having no evidence of obstruction on follow-up imaging.
Conclusions:
- Robot-assisted pyeloplasty is a safe and effective surgical option for infant ureteropelvic junction obstruction.
- The procedure demonstrates successful outcomes in minimally invasive pediatric surgery.
- Further long-term studies are warranted to confirm the sustained benefits of robotic surgery in this population.
Purpose:
Robot assisted pyeloplasty is emerging as an effective tool for treatment of ureteropelvic junction obstruction in the pediatric population. However, access needed for the procedure is difficult in the small abdominal cavity of an infant. We present our experience with infant robot assisted pyeloplasty, along with some lessons learned that render this procedure possible in these small patients.
Materials And Methods:
Nine children 3 to 8 months old (mean 5.6) underwent transperitoneal robot assisted pyeloplasty for ureteropelvic junction obstruction using the da Vinci Surgical System. All patients underwent Anderson-Hynes dismembered pyeloplasty without renal pelvis tapering. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography and/or diuretic radionuclide imaging.
Results:
All infants successfully underwent robot assisted laparoscopic pyeloplasty without conversion to pure laparoscopy or open procedure. Mean operative time was 122.8 minutes, with a mean console time of 72.1 minutes. Mean hospital stay was 1.4 days. Of the 9 patients 7 (78%) had resolution of or improvement in hydronephrosis, while 2 had no evidence of obstruction based on followup diuretic renography.
Conclusions:
Robot assisted pyeloplasty is a safe and effective option in the surgical treatment of infant ureteropelvic junction obstruction. Further long-term studies are needed to confirm the usefulness of robotics in minimally invasive pediatric surgery.
