Investig Clin Urol.  2017 Jan;58(1):3-11. 10.4111/icu.2017.58.1.3.

Lessons learned over a decade of pediatric robotic ureteral reimplantation

• Baek M
• Koh CJ

• KMID: 2365090
• DOI: http://doi.org/10.4111/icu.2017.58.1.3

Abstract

The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.

Keyword

Child; Laparoscopy; Robotics; Urologic surgical procedures; Vesico-ureteral reflux

MeSH Terms

Child
Consensus
Human Engineering
Humans
Laparoscopy
Learning Curve
Male
Parents
Population Characteristics
Prostatectomy
Prostatic Neoplasms
Replantation*
Robotics
Surgeons
Ureter*
Urologic Surgical Procedures
Vesico-Ureteral Reflux

Figure

• 

  Fig. 1 Personal historical perspective of pediatric robotic surgical cases over the past decade that include intravesical RALUR (ureteral reimplantation) cases. RALUR remains a significant procedure in terms of surgical volume, and second in volume only to robotic pyeloplasty. RALUR, robot-assisted laparoscopic ureteral reimplantation.

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