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S20-9
(P)
A COMPARATIVE STUDY OF PEDIATRIC OPEN PYELOPLASTY, LAPAROSCOPY-
ASSISTED EXTRACORPOREAL PYELOPLASTY AND ROBOT-ASSISTED
LAPAROSCOPIC PYELOPLASTY
Sang Hoon SONG
1
, Chanwoo LEE
1
, Jaeyoon JUNG
1
, Jae Shin PARK
2
and Kun Suk KIM
1
1) Asan Medical Center, University of Ulsan College of Medicine, Department of Urology, Seoul, KOREA (REPUBLIC OF) -
2) Daegu Catholic University Medical Center, Department of Urology, Daegu, KOREA (REPUBLIC OF)
PURPOSE
We perform open, laparoscopy assisted extracorporeal and robotic-assisted pyeloplasty and have compared these
techniques regarding the per-operative variables and post-operative outcomes.
MATERIAL AND METHODS
We retrospectively reviewed the age-matched cohort of 30 children who underwent open pyeloplasty (OP), 30 children
who underwent laparoscopy-assisted extracorporeal pyeloplasty (LEXP), and 10 children who underwent robot-assisted
laparoscopic pyeloplasty (RALP) at a single institution. Successful surgery was defined as resolution of symptoms,
improvement of hydronephrosis on follow-up ultrasound, and improvement of drainage on diuretic renal scan without
history of ureteral stent re-insertion or re-do pyeloplasty.
RESULTS
The mean value of age was 120.2 months, SFU grade was 3.6, anteroposterior diameter was 3.1cm, and relative
function was 44.0%. Aberrant vessel compressing the ureteropelvic junction was identified in 10% in OP, 23.3% in
LEXP, and 50% in RALP (p=0.031). Mean length of stay was significantly shorter in RALP (3.2 days) than in OP (6.6
days) or in LEXP (5.8 days) (p<0.001). Duration of analgesics use was also shorter in RALP (1.1 days) than others
(p<0.001). Complications after surgery was noted in 4 cases of OP and LEXP group. Malfunction of the robot arm was
once reported in RALP group. During the mean follow up period of 49.0, 20.1, and 6 months, success rate was 96.7%,
89.7%, and 100%, which was not statistically different in OP, LEXP, and RALP group, respectively (p=0.499). In
multivariate regression analysis, presence of aberrant vessel was the only factor that deteriorates successful outcome
(Hazard ratio=46.09, 95% CI 2.41-879.6, p=0.011). In 3 patients (20.0%) of those 15 with aberrant vessel,
hydronephrosis improved after endopyelotomy or re-do pyeloplasty.
CONCLUSIONS
Robotic pyeloplasty showed a decreased length of hospital stay and use of pain medication, however, there was no
difference in success rate between the open, laparoscopic and robotic surgery.