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INNOVATION IN ROBOTICS AND PEDIATRIC UROLOGY: ROBOTIC
URETEROURETEROSTOMY
Julia FINKELSTEIN, Mark SILVA, Sarah LAMBERT and Pasquale CASALE
Columbia University College of Physicians & Surgeons, Urology, New York, USA
PURPOSE
Robotic technology has increasingly been utilized for complicated reconstructive surgeries in pediatric urology, such as
ureteroureterostomy (UU). There are only 9 publications, encompassing 45 patients, regarding pediatric minimally
invasive UU. We sought to evaluate and report on our pediatric experience with robot-assisted laparoscopic UU.
MATERIAL AND METHODS
With approval from the Institutional Review Board, a retrospective chart reviewed was performed of all pediatric patients
who underwent a robot-assisted laparoscopic UU by 2 pediatric urologists at our institution over a two-year period, from
March 2013 to March 2015. An externalized ureteral catheter was kept overnight and was generally removed with the
indwelling urinary catheter on post-operative day #1. Intraoperative as well as postoperative complications including
hematuria, fever, and urinary tract infections (UTIs) were recorded. Follow up renal ultrasound was done at 3 months.
RESULTS
Overall, 12 patients (4 male, 8 female) underwent robotic UU at a mean age of 19.4 months (range 9-48 months)
during the study time period. The majority of patients (81.8%) initially presented with antenatal hydronephrosis and all
were found to have ureteral ectopia. Mean weight of the cohort at the time of surgery was 11.8 kg (range 9-14.2 kg).
One child had bilateral surgery. Mean operative time was 167 minutes (range 100-345 minutes) and mean estimated
blood loss was 1.5 cc (range 0-3). There were no intraoperative complications and no case required open conversion.
Mean length of hospital stay was 1 day. One patient developed a febrile UTI postoperatively. All patients experienced
improvement in symptoms and/or became dry. Overall success rate was 100%.
CONCLUSIONS
Our institutional results demonstrate that robot-assisted laparoscopic ureteroureterostomy is a safe and effective
technique to manage duplicated, ectopic ureters in children.