Ciro Esposito1, Lorenzo Masieri2, Thomas Blanc3, Gianantonio Manzoni4, Selcuk Silay5, Maria Escolino6. 1. Division of Pediatric Urology, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it. 2. Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy. 3. Division of Pediatric Urology, Hôpital Necker-Enfants Malades, Paris, France. 4. Division of Pediatric Urology, Ospedale Maggiore Policlinico, Milan, Italy. 5. Division of Pediatric Urology, Istanbul Medeniyet University, Istanbul, Turkey. 6. Division of Pediatric Urology, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Abstract
PURPOSE: This multicentric study aimed to report our experience with robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidney (HSK). METHODS: The records of 14 patients (11 boys and 3 girls with an average age of 9 years), who underwent RALP for repair of pelvi-ureteric junction obstruction (PUJO) in HSK in five international pediatric urology units over a 5-year period, were retrospectively reviewed. A dismembered pyeloplasty with no division of isthmus was performed in all the cases. RESULTS: The average operative time including docking was 143.5 min (range 100-205). No conversions to laparoscopy or open surgery or intra-operative complications occurred. Patients were discharged on postoperative day 2 following catheter and drain removal. The JJ stent was removed at mean 33 days postoperatively. Overall success rate was 92.8%. As for postoperative complications, we recorded a urinary tract infection (UTI) and stent-related irritative symptoms, managed with medical therapy, in two patients (II Clavien) and an anastomotic stricture in one patient needing surgical revision with no further recurrence (IIIb Clavien). At follow-up, all the patients (one after redo-surgery) reported complete resolution of symptoms, improvement of hydronephrosis on ultrasound and no residual obstruction on diuretic renogram. CONCLUSIONS: Our experience suggested that RALP in HSK is safe, feasible and with good medium-term outcomes in expert hands. An accurate pre-operative planning associated with a standardized technique is key points to achieve good surgical and functional outcomes in these challenging cases. The da Vinci robot technology offers the advantages of MIS procedures and overcomes the technical challenges of laparoscopic approach.
PURPOSE: This multicentric study aimed to report our experience with robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidney (HSK). METHODS: The records of 14 patients (11 boys and 3 girls with an average age of 9 years), who underwent RALP for repair of pelvi-ureteric junction obstruction (PUJO) in HSK in five international pediatric urology units over a 5-year period, were retrospectively reviewed. A dismembered pyeloplasty with no division of isthmus was performed in all the cases. RESULTS: The average operative time including docking was 143.5 min (range 100-205). No conversions to laparoscopy or open surgery or intra-operative complications occurred. Patients were discharged on postoperative day 2 following catheter and drain removal. The JJ stent was removed at mean 33 days postoperatively. Overall success rate was 92.8%. As for postoperative complications, we recorded a urinary tract infection (UTI) and stent-related irritative symptoms, managed with medical therapy, in two patients (II Clavien) and an anastomotic stricture in one patient needing surgical revision with no further recurrence (IIIb Clavien). At follow-up, all the patients (one after redo-surgery) reported complete resolution of symptoms, improvement of hydronephrosis on ultrasound and no residual obstruction on diuretic renogram. CONCLUSIONS: Our experience suggested that RALP in HSK is safe, feasible and with good medium-term outcomes in expert hands. An accurate pre-operative planning associated with a standardized technique is key points to achieve good surgical and functional outcomes in these challenging cases. The da Vinci robot technology offers the advantages of MIS procedures and overcomes the technical challenges of laparoscopic approach.
Authors: Christian Schwentner; Alexandre Pelzer; Richard Neururer; Brigitte Springer; Wolfgang Horninger; Georg Bartsch; Reinhard Peschel Journal: BJU Int Date: 2007-05-29 Impact factor: 5.588
Authors: Marco Oderda; Giorgio Calleris; Marco Allasia; Ettore Dalmasso; Marco Falcone; Massimo Catti; Emilio Merlini; Paolo Gontero Journal: Urologia Date: 2016-08-02