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28
TH
CONGRESS OF THE ESPU
S15: LAPAROSCOPY / ROBOTICS
Moderators: Tiago Rosito (Brazil), Simona Gerocarni Nappo (Italy)
ESPU Meeting on Friday 21, April 2017, 10:30–11:26
10:30–10:35
S15-1 (LO)
PREDICTORS OF HIGH-GRADE COMPLICATIONS
IN PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC
UROLOGIC SURGERY ON THE LOWER URINARY TRACT
Nimrod BARASHI
1
, William BOYSEN
1
, Eric SCHADLER
2
, Vignesh PACKIAM
1
and Mohan S. GUNDETI
1
1) The University of Chicago, Section of Urology, Chicago, USA - 2) The University of Chicago, Pritzker School
of Medicine, Chicago, USA
INTRODUCTION
The use of robot-assisted laparoscopic (RAL) surgery in pediatric urology has increased in recent
years. We sought to analyze our institutional experience with RAL surgery on the lower urinary tract
to identify the incidence of grade III or higher Clavien-Dindo complications, and assess for factors
associated with complications.
PATIENTS AND METHODS
We retrospectively reviewed our single-surgeon experience performing RAL surgery on the lower
urinary tract in children from 2007 to 2016. The patients were grouped according to type of surgery:
Appendicovesicotomy with or without Augmentation Ileocystoplasty, and Ureteral Reimplantation
(UR). Statistical analysis was performed using a multivariate regression model and Fisher’s exact
test.
RESULTS
We identified 127 patients who underwent RAL lower tract surgery, 8 (6.3%) were converted to
open and excluded from the analysis. A total 119 patients were included, 87 cases of UR and 32 of
Augmentation/Appendicovesicotomy, with a median follow up time of 9 (IQR 4-16) and 40.5 (IQR
13.75-81.5) months, respectively. Relative to the UR group, patients undergoing complex bladder
procedures had a higher rate of grade III complications (28.13% vs. 1.15%, p<0.01) and one grade
IV complication (3.125%) consisting of postoperative urinary sepsis. On univariate analysis, higher
EBL and longer operative time were associated with increased odds of grade III complications (OR
1.02 and 1.01, p=0.04 and p=0.02, respectively); age and BMI were not (p>0.05).
CONCLUSIONS
This series highlights the safety of RAL UR, with no complications related to access and low inci-
dence of major complications on long-term follow up. The incidence of high-grade complications in
the bladder procedures group was consistent with reported values for other approaches, reflecting
the inherent morbidity of these procedures. Longer operative time and higher EBL, possible sur-
rogates for case complexity, were associated with increased rates of grade III complications.