Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

S20: LAPAROSCOPY / ROBOTICS 1

Moderators: Duncan Wilcox (USA), Yves Heloury (Australia)

ESPU Meeting on Friday 16, October 2015, 16:52 - 17:30

16:52 - 16:57

S20-1

(LO)

★

ROBOT-ASSISTED LAPAROSCOPIC URETERONEOCYSTOSTOMY CARRIES

HIGHER RISK OF SURGICAL COMPLICATIONS THAN OPEN REIMPLANT: A

RETROSPECTIVE ANALYSIS OF 6,090 CASES FROM 44 CHILDREN'S HOSPITALS

Moira DWYER

, Jonathan ROUTH

, Michael OST

, Heidi STEPHANY

, Francis SCHNECK

, Patricio GARGOLLO

and Glenn

CANNON, JR.

1) Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Urology, Pittsburgh, USA - 2) Duke

University Medical Center, Surgery, Urology, Durham, USA - 3) Texas Children's Hospital, Surgery, Urology, Houston,

USA

PURPOSE

Although robot-assisted laparoscopic ureteroneocystostomy is being more commonly used, no multi-center reports have

validated this approach through comparison with the gold standard of open ureteroneocystostomy. We set out to

compare these procedures using a nationalwide database.

MATERIAL AND METHODS

We retrospectively queried the Pediatric Health Information System (PHIS), which keeps information from 47

contributing American children’s hospitals.

RESULTS

From 2008 through 2013, urologists performed inpatient ureteroneocystostomies on 10,277 patients with vesicoureteral

reflux under age 18. Of these, 2.11% were robotic (217/10,277) excluding 10 that were converted to open (4.4%,

10/227). There were 5,940 open cases (59.05%) and 150 robotic procedures (69.12%) that met exclusion

criteria. Average patient age by year was 4.40 (median 4, range 0-17) and 5.67 (median 5, range 0-17), respectively

(p<0.0001). Male-to-female ratio was 0.23 and 0.19, respectively (p=0.52). Average postoperative length of stay by

day was 1.82 (median 2, range 1-13) and 1.53 (median 1, range 1-8), respectively (p<0.001). The robotic cohort had

significantly more surgical complication flags (1.5% [87/5,940] open vs. 4.7% [7/150] robotic, p=0.008), urinary

surgical complications (0.3%, 19/5,940 open vs. 3.3%, 6/150 robotic; p=0.0002), complicating urinary retention

(0.1%, 6/5,940 open vs. 1.5%, 2/150 robotic; p=0.02), acute renal failure (0.5%, 21/5940 open vs. 1.5%, 2/150

robotic; p=0.02), and accidental operative lacerations (<0.001%, 5/5,940 open vs. 0.7%, 1/150 robotic;

p=0.009). Also, significantly more procedures were performed for genitourinary imaging in the robotic cohort

(retrograde pyelograms: 0.1%, 54/5,940 open vs. 6.0%, 9/150 robotic, p<0.0001; other: 0.7%, 44/5,940 open vs.

3.3%, 5/150 robotic, p=0.007). There were no significant differences in proportions of readmissions at 30 or 90 days

(p=0.55-0.74).

CONCLUSIONS

In a large, hospital-based statistical analysis, pediatric robot-assisted laparoscopic ureteroneocystostomy had a greater

risk of surgical complications compared to open ureteroneocystostomy.