Robotic Pyeloplasty in Children: A "Barbed" Shortcut

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Surgical Sutures

Background:

• Dismembered pyeloplasty is the standard for pelviureteric junction obstruction (PUJO).
• Robotic pyeloplasty (RP) is an increasingly popular and effective minimally invasive approach for PUJO.
• Barbed sutures, like V-Loc, offer an alternative for pelvic closure during pyeloplasty.

Purpose of the Study:

• To evaluate the authors' experience using V-Loc sutures for pelvic closure in pediatric robotic pyeloplasty.
• To compare the outcomes of V-Loc sutures with traditional Vicryl sutures in this patient population.

Main Methods:

• A retrospective review of 10 pediatric robotic pyeloplasties using V-Loc sutures.
• Comparison with 15 pediatric robotic pyeloplasties using 5-0 Vicryl sutures.
• Standard Anderson-Hynes technique with intraoperative JJ stent placement was used in all cases.

Main Results:

• The V-Loc group experienced a 40% rate of worsening hydronephrosis and drainage post-stent removal, requiring further intervention.
• Histology in V-Loc cases revealed a "plaque-like" inflammatory reaction at the pelvic suture line.
• One case (6.67%) in the Vicryl group required redo-pyeloplasty due to a stent-related complication.

Conclusions:

• V-Loc suture use for pelvic closure in pediatric robotic pyeloplasty is associated with a significant risk of hydronephrosis and need for repeat procedures.
• Asymptomatic presentation of complications necessitates vigilant postoperative surveillance.
• Further investigation into the inflammatory response to V-Loc sutures in this context is warranted.