“Prospective analysis of completely stentless robot-assisted pyeloplasty in children.”
Casale, P. and S. Lambert (2009).
Journal of Robotic Surgery: 1-3.
Robot-assisted pyeloplasty (RAP) is emerging as an effective tool for treatment of ureteropelvic junction obstruction (UPJO) in the pediatric population. Typically stents are utilized for RAP and removed four weeks after the procedure. We present our prospective experience with stentless RAP. Twenty children between the ages of 12 and 113 months (mean age 56 months) underwent transperitoneal RAP for UPJO utilizing the DaVinci surgical system. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography, magnetic resonance urography (MRU), and/or diuretic radionuclide imaging (DRI). All patients successfully underwent robot-assisted laparoscopic pyeloplasty without conversion to pure laparoscopy or open procedure. Mean operative time was 124.7 min with a mean console time of 82.3 min. The mean hospital stay was 18 h. Of the 20 patients, 13/20 (65%) had resolution or improvement in the degree of hydronephrosis. The other patients had no evidence of obstruction based upon follow-up MRU or DRI. Stentless RAP is a safe and effective option for surgical treatment of UPJO. A larger prospective long-term cohort is needed to confirm the safety and efficacy of the stentless approach. © 2009 Springer-Verlag London Ltd.
“Robotic hypospadias surgery: a new evolution.”
Casale, P. and T. S. Lendvay (2009).
Journal of Robotic Surgery: 1-6.
The dictum that “there is nothing new in surgery not previously described,” is quoted regularly and is particularly true of hypospadias. There is an ongoing search for solutions to many troublesome issues concerning surgical treatment of hypospadias, such as what age is the most appropriate to apply surgery, or in how many stages surgery should be performed. We present a case report of the first robotic hypospadias surgery to propose a departure from the standard practice, in the hope of expanding medical expertise and teaching globally. The use of a robot for reconstructive surgery is not novel; its use for extracorporeal surgery is, but we contend that there is no difference in the surgical steps to carry out a hypospadias repair. In addition, we envision that the benefits of applying robotic surgery for extracorporeal reconstructive procedures will greatly impact the current paradigm of surgery and surgical education. For those surgeons who already possess comfort with robotic skills, reconstructive procedures outside of a major cavity are feasible, and time will provide safety and efficacy data. Our hope is that others will join in the advancement of telesurgery and its applications and appreciate the potential expansion of surgical knowledge that will be afforded by this change in how we teach and operate. © 2009 Springer-Verlag London Ltd.
“Robot-Assisted Laparoscopic Nephrectomy and Contralateral Ureteral Reimplantation in Children.”
Lee, R. S., A. S. Sethi, et al. (2009).
Abstract Background: Robot-assisted laparoscopic surgery (RALS) has expanded the role for minimally invasive surgery within pediatrics. RALS may be particularly beneficial for the treatment of children with a refluxing nonfunctioning renal moiety and contralateral vesicoureteral reflux. In this report, we describe a single RALS procedure, which includes both nephrectomy or partial nephrectomy, and contralateral extravesical ureteral reimplantation (EVUR). Methods: A retrospective review was performed of four patients who underwent RALS nephrectomy/partial nephrectomy and concurrent EVUR in one setting. Procedures were performed by a single surgeon using a robot-assisted laparoscopic approach. Four ports were used in a transperitoneal approach with patient positioning changed without moving the robotic system between the nephrectomy and reimplant. We described the technique and assessed its safety and efficacy. Results: All cases were treated with the single RALS approach. Mean patient age was 2.3 years. Three patients underwent a nephrectomy and one a lower pole partial nephrectomy. The mean estimated blood loss was 16 mL, mean operative time was 291 minutes, and mean length of stay was 2.3 days. There was one case of postoperative ureteral obstruction that was treated with 3 weeks of ureteral stenting without further sequela. Overall, the mean follow-up time was 21 months and follow-up renal ultrasonographs and radionuclide cystograms were normal in all patients. Conclusions: A single RALS procedure that combines nephrectomy/partial nephrectomy and EVUR offers a novel approach to a clinical dilemma that often requires two operations. In this small series, RALS was safe and efficacious. We recommend routine Double-J stenting for the solitary reimplanted ureter.
“Pediatric robotic-assisted surgery: Too early an assessment?”
Peters, C. A. (2009).
Pediatrics 124(6): 1680-1681.
“Robot-assisted laparoscopic ureteroureterostomy for proximal ureteral obstructions in children.”
Smith, K. M., D. Shrivastava, et al. (2009).
Journal of Pediatric Urology 5(6): 475-479.
Objective: Ureteropelvic junction obstruction is a common presentation in the pediatric population, but proximal ureteral obstructions are rare. In this setting, robot-assisted laparoscopy (RAL) offers a minimally invasive option to open or traditional laparoscopic repair. The present study demonstrates successful RAL in two children with proximal ureteral obstructions: one with a right retrocaval ureter and one with a left ureter entrapped between two lower-pole crossing vessels. Method: After retrograde placement of a double-J ureteral stent, the child was secured in a lateral decubitus position exposing the affected side. A three-port RAL system was used to dissect free the obstructed ureter. A spatulated watertight ureteroureterostomy was then fashioned after transposition of the ureter into an anatomic position. Sutures and free instruments were passed into the peritoneal cavity via the 5-mm instrument ports, thus obviating the need for a separate assistant port. Results: RAL provided for crisp visualization, meticulous dissection, and precise approximation of the reconstructed ureter. In both patients, blood loss was negligible, narcotic use was minimal, and length of stay was roughly 30 h. Follow-up imaging at 1 month showed excellent hydronephrosis resolution for both reconstructions. Conclusion: These two cases demonstrate the feasibility of RAL for proximal ureteral anomalies in the pediatric population. © 2009 Journal of Pediatric Urology Company.