Utilization of robotics for retroperitoneal lymph-node dissection in pediatric and non-pediatric hospitals

The objective of this study is to determine recent trends in use of robotics and laparoscopy for pediatric retroperitoneal lymph-node dissection (RPLND) in pediatric and non-pediatric hospitals. We conducted a retrospective cohort study using data from 29 hospitals in the Pediatric Health Information System (PHIS), and data from 14 states in the State Inpatient Databases (SID), between 2008 and 2014. The study population was comprised of patients aged ≥ 10 years undergoing RPLND, with an inpatient diagnosis of testicular or paratesticular cancer, based on international classification of disease (ICD) codes. Robotic approach was identified by the presence of an ICD procedure code modifier. During the study period, a total of 90 RPLNDs were performed in pediatric hospitals (median patient age 16 years). Of these, 4 (4.4%) were performed robotically. A total of 3120 RPLNDs were performed in non-pediatric hospitals (median patient age: 32 years). Among these, 269 (8.6%) were performed robotically, with an increasing trend in the use of robotic RPLND (adjusted annual increase in probability of undergoing robotic vs. open procedure: 16%; 95% CI 8-24). Undergoing robotic RPLND was associated with a reduction in postoperative length of stay of 3.5 days (95% CI 2.9, 4.1). Open surgical approaches comprise the vast majority of RPLNDs performed at pediatric hospitals. This is in contrast with trends in non-pediatric hospitals where robotic RPLND is being increasingly utilized. Future research is necessary to investigate this discrepancy in adopting minimally invasive techniques for RPLND in pediatric centers.