BERKELEY, CA (UroToday.com) - This study out of Boston Children's by Passerotti, et al described the group's technique utilizing robotics for ureteroureterostomy in patients with mid ureteral obstructions. The group had 3 patients, 2 who were boys and 1 girl with their ages being 4.7, 9.6 and 14.3 years. These patients all had mid ureteral strictures and obstruction. Two were congenital in nature and one was due to a stone. All three procedures were performed without any intraoperative or postoperative complications. The mean hospital stay was 3.5 days. Two of the patients had ureteral stents but it was unclear why the third did not require one.

The group followed these patients for a mean of 11.6 months with the range of 1.3-25.5. Two of the patients demonstrated complete resolution of hydroureteronephrosis and one other patient showed a significant improvement on ultrasonography. All the patients were asymptomatic at their most recent follow up. Other imaging modalities were not performed to rule out obstruction. I agree with this practice. In my opinion, I do not feel these are necessary as I find it hard to believe that you do have true obstruction without caliectasis. Once caliectasis is not part of the postoperative findings on ultrasound, the likelihood that true obstruction really exists is extremely low.

The paper went on to describe the role of robotics in urologic practice. Key points from this discussion are as follows. It has evolved dramatically over the past 10 years. Most of the procedures performed are reconstructive in nature. As our comfort level increases with the robotic approach, a complex upper tract reconstruction as well as bladder reconstruction is approached more readily. At The Children's Hospital of Philadelphia we published a paper in the Journal of Endourology 21(6) 619-622, June 2007 on both laparoscopic and robotic complex upper tract reconstruction in children with duplicated systems. We found the approach both at the renal level and the bladder level to be easier to perform in a robotic fashion as compared to a laparoscopic secondary to the 3-dimenstional visualization and dexterity that is added with the robotic platform.

The group concluded that robotic assisted laparoscopic ureteroureterostomy appears to be a safe and feasible approach in pediatric patients as well as effective in their experience. Robotics does have a bright future in the pediatric population. It was meant for reconstruction and since the majority of pediatric patients require reconstructive more than extirpative surgery, we can truly define where this technology will be best suited for our patients.

Passerotti CC, Diamond DA, Borer JG, Eisner BH, Barrisford G, Nguyen HT

J Endourol. 2008 Feb 28
10.1089/end.2007.9838

PubMed Abstract
PMID: 18307382

UroToday.com Pediatric Urology Section

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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