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Prospective Robotically-Assisted Laparoscopic Pyeloplasty Analysis in Pediatrics
Kelly Chiles1, Katherine W Herbst2, Christina Kim2
1University of Connecticut, Farmington, CT;2Connecticut Children's Medical Center, Hartford, CT

Introduction:
Dismembered pyeloplasty was historically done with an open incision, but less invasive techniques have taken a more prominent role. Many studies review outcomes in a retrospective fashion. We performed a prospective analysis of pediatric robotically-assisted laparoscopic pyeloplasties (RALP) to further establish the safety and effectiveness of this minimally invasive surgery.
Materials & Methods:
After obtaining IRB approval, all patients scheduled for RALP after March 2009 were offered enrollment in our database.
Results:
Twenty four of the twenty six enrolled patients have undergone surgery. Mean age is 5.4 years; mean weight is 27.3 kg. Two patients were redo repairs.
Mean anesthesia time was 296 minutes, and mean surgical time from first incision to final suture was 188 minutes.
Mean hospital stay was 1.4 days. Mean follow up was 8.5 months. Mean narcotic use per patient was 0.4 mg/kg of morphine intravenous equivalent. There were four postoperative complications (16%): two major and two minor. One patient had omental herniation during drain removal, one returned to the emergency room for bladder spasms, and two had repeat surgeries.
Postoperative imaging revealed worsened hydronephrosis in two patients (8%). One patient underwent a re-do RALP and the other underwent endoscopic incision of scar tissue.
Conclusions:

On this prospective review, we found RALP continues to be a safe and comparable alternative to open UPJ obstruction repair. We will continue with long-term follow up and active recruitment of patients. We hope this helps solidify benchmarks for robotic surgical Results in pediatric UPJ obstructions.


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