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2008 Annual Meeting Abstracts
Robotic-assisted Laparoscopic Ureterocalicostomy in the Pediatric Population
Phillip Mucksavage1, Steve Kim2, Matt J Resnick1, Pasquale Casale2
1University of Pennsylvania Health System, Philadelphia, PA;2Childrens Hospital of Philadelphia, Philadelphia, PA
Introduction: Ureterocalicostomy is an alternative approach to ureteropelvic junction (UPJ) obstruction in patients with a significantly scarred or inaccessible UPJ. We report the first series of robotically assisted laparoscopic ureterocalicostomy (RALU) in the pediatric population.
Methods:
Patients who underwent transperitoneal RALU as primary or secondary treatment for UPJ obstruction were reviewed. Diuretic renal scintigraphy (DRI) and renal bladder ultrasound were obtained prior to surgery. Outcome measured included operative time and length of hospital stay. Post operative follow up included ultrasound at 3 months and DRI at 6 and 12 month.
Results:
Nine patients (age ranges 3 to15 years, mean 6.5) underwent RALU. Of the 9 patients, 6 had previous UPJ surgery, while 3 presented primarily. Six patients had stenotic UPJs in which 4 had previous UPJ surgery. Three patients had crossing vessel pathology. Mean operative time was 168 minutes (range 102 - 204) for the ureterocalicostomy portion. Two patients had concomitant renal calculi and underwent pyeloscopy and stone removal at the time of the surgery requiring an additional 14 and 21 minutes. The mean hospital stay was 21 hours (range 17 - 26). Ultrasounds performed 3 months after stent removal showed persistent dilation. DRI was performed in all the patients at 6 and 12 months after surgery revealing no evidence of obstruction in any patients.
Conclusions:
This is the first series of RALU in the pediatric population. It appears to be a feasible, safe and successful operation in this population.
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