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Complications of Pediatric Urologic Minimally Invasive Surgery
Shailen Sehgal1, Matthew Christman2, Pasquale Casale2
1University of Pennsylvania, Philadelphia, PA;2Children's Hospital of Philadelphia, Philadelphia, PA

Introduction: The incidence of any complication development with adult laparoscopic surgery is reported to be between 3.5 and 9.3%. To our knowledge, there are no large-scale, prospective published reports concerning the incidence of complications with Pediatric Urologic Minimally Invasive Surgery (PUMIS). We present our experience with complications in PUMIS.
Materials and Methods: We prospectively followed 600 minimally invasive cases performed at our institution. We described complications as any deviation from normal postoperative course, and categorized our complications according to the Clavien system.
Results: Median age was 3.2 yr. (0.4 - 18.8). Median follow-up was 29 months (12-83.4). There were 1895 port sites analyzed in the 600 cases. The 600 cases comprised of 116 testicular; 267 renal/ureteral; 209 bladder; 6 retroperitoneal lymph node dissections; and 2 pelvic cases for removal of Mullerian remnants. There were 7 port site complications (3 umbilical hernias and 4 lateral site superficial infections). Four children had intra-abdominal urinary leakage (1 nephroureterectomy; 1 pyeloplasty with stent migration; 1 nephrectomy; 1 ureteral reimplant). One ureteral reimplantation had a blood loss of 150 cc while the remaining cases were negligible for blood loss. There were 7 Clavien I and 5 Clavien IIIb complications in the 600 cases.
Conclusions
: Incidence of complications with PUMIS was 2.0% overall which is slightly lower than the published incidence in adults undergoing minimally invasive surgery. Although it appears safe to perform PUMIS, we must continue to carefully monitor our outcomes in this evolving sub-specialty.


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