NARUS 2018: What are the Results in Robotic-Assisted Laparoscopic Pyeloplasty in an Emerging Country? Prospective Series in Pediatric Patients
Between March 2015 and December 2017 at a single institution, 19 patients underwent robotic pyeloplasty. Variables assess included demographic data, diagnoses, surgical technique, console time, bleeding, need for transfusion, complications, conversions, and postoperative length of stay. For this procedure, the authors did a dismembered Anderson-Hynes type robotic pyeloplasty using the da Vinci Si system. They used three robotic 8 mm arms (lens plus two working arms) and one laparoscopic 5 mm arm. The urinary catheter was removed after 24 hours, a BLAKE drain was removed at 48 hours, and the double J catheter was removed a month later. Follow-up at 120 days included a renal ultrasound and functional study.
Among these 19 patients, the mean age was 48 months (range 4-156), 65% were males, and the most common cause of ureteropelvic junction obstruction was intrinsic (84%). The mean time at the console was 183 minutes (range 90-279), there were no transfusions, and no conversions to open. The mean length of stay was 3.2 days (range 2-12 days). Postoperatively, there was one Clavien type I complication (urine leak) and one type IIIb (urinoma – percutaneously drained). After 17.5 months of follow-up (range 7 days – 32 months), the success rate was 100%.
The authors concluded that pyeloplasty in children requires minimally invasive advanced skills with a variable learning curve. Robotic assistance is ideal for increasing the capabilities of the surgeon, and has safety and feasibility equal or greater to that of open surgery.
Presented By: Mario Navarrete Arellano, Military Central Hospital, Mexico City, Mexico
Co-Authors: Francisco Garibay Gonzalez
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV