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VR-19
(VS)
ROBOTIC-ASSISTED LAPAROSCOPIC EXCISION OF MULTIFOCAL URETERAL AND
RENAL PELVIS POLYPS
Jonathan ELLISON and Thomas LENDVAY
Seattle Children's Hospital, Pediatric Urology, Seattle, USA
PURPOSE
Fibroepithelial polyps are a rare cause of upper urinary tract obstruction in children. While endoscopic management is
preferred in many cases, large or multi-focal polyps may preclude endoscopic management. Presented here is a case of
a 9 year old with large, multifocal obstructive ureteral and renal pelvis polyps managed with robotic-assisted excision.
MATERIAL AND METHODS
After pre-operative evaluation confirmed the presence of obstructive polyps, a robotic-assisted approach was
chosen. Standard robotic set-up for upper urinary tract surgery was planned, utilizing two robotic surgeon arms and a
working port for the bedside assistant. A ureterotomy was made in the proximal ureter, exposing the ureteral
polyps. Counter-incisions were made distally on the ureter in order to identify additional polyps and the anterior portion
of the ureter was opened to expose all involved urothelium. Polyps were excised with electrocaudery. Intra-corporeal
ureterorenoscopy confirmed the excision of all significant polyp disease. The ureterotomy was closed in a water-tight,
running anastomosis over a ureteral stent.
RESULTS
Final pathology confirmed the presence of fibroepithelial polyps of the urinary tract. The patient is currently without
signs or symptoms of recurrent obstruction.
CONCLUSIONS
Robotic-assisted laparoscopy is a safe and feasible alternative to endoscopic treatment of fibroepithelial polyps. The
robotic platform may be especially applicable for large or multifocal polyps of the ureter or renal pelvis.