MAAUA 68th Annual Meeting Abstracts
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Pediatric Robotic Extravesical Ureteral Reimplantation: a Comparison with Open Surgery
Ryan P Smith, *Janine Oliver, Craig A Peters
University of Virginia, Charlottesville, VA
Introduction: Robotic-assisted laparoscopic ureteral reimplantation is a potential alternative to open reimplantation. To date, no direct comparison of age-matched cohorts exists to compare outcomes to open reimplantation.
Methods: A retrospective chart review was conducted of all 23 pediatric patients with a mean age of 65 months (range 3 to 144) who underwent robotic-assisted laparoscopic extravesical ureteral reimplantation for unilateral or bilateral vesicoureteral reflux from 2006 to 2009. Twenty-three patients undergoing open cross-trigonal ureteral reimplantation over the same time period were identified as age and weight-matched controls.
Results: All robotic procedures were completed without intraoperative complications. The mean operative time was longer in the robotic group (189 min) as compared to age-matched (165 min; P = 0.04) and weight-matched (165 min; P = 0.01) controls. Mean length of stay (33 hours vs. 53 hours) and pain medication usage (0.30 mg/kg morphine equivalents vs. 0.86 mg/kg) were less in the robotic group (P < 0.001). No radiographic evidence of reflux was observed in 97% of children undergoing robotic reimplantation with a mean follow-up of 27.8 months. In the open cohort, the reflux resolution rate was 100% in those undergoing post-operative VCUG. No patients developed post-operative febrile urinary tract infections.
Conclusions: Our series demonstrates decreased length of stay and use of postoperative narcotics with a 14% increase in operative time. This early series shows success rates similar to the open approach. Robotic-assisted laparoscopic extravesical ureteral reimplantation appears to be a safe and efficacious option for repair of vesicoureteral reflux.
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