116 / 238
116
29
th
CONGRESS OF THE ESPU
08:58–09:01
S14-3 (PP)
RETROPERITONEAL APPROACH FOR URETEROPELVIC
JUNCTION OBSTRUCTION: MOVING FROM
LAPAROSCOPIC TO ROBOT-ASSISTED LAPAROSCOPIC
REPAIR. PRELIMINARY RESULTS
Thomas BLANC, Pauline CLERMIDI, Henri LOTTMANN, Nathalie BOTTO, Luca PIO
and Yves AIGRAIN
Hôpital Necker - Enfants Malades, Department of Pediatric Surgery and Urology, Paris, FRANCE
PURPOSE
Robot-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among pediatric
urologists. Few studies have evaluated the retroperitoneal approach of RALP. Our aim was to evalu-
ate our preliminary results in terms of safety and efficacy during the first year of a muldisciplinary
paediatric robotic program.
MATERIAL AND METHODS
We performed a prospective analysis of children undergoing RALP for ureteropelvic junction ob-
struction (n=22). The diagnosis of ureteropelvic junction obstruction was confirmed by ultrasound
and Tc-99m mercaptoacetyltriglycine renal scan or MRI; same criteria were used to evaluate the
outcome. The retroperitoneal approach was done according to specific algorithm. Transperitoneal
approch (n: 8) was chosen for horseshoe kidney, ectopic kidney, and redo surgery. We analysed the
14 cases done through the lateral retroperitoneal approach. Dismembered pyeloplasty was done
for all, anastomosis was performed using a running monofilament 6/0 absorbable suture. All were
drained by double J.
We evaluated operating room parameters and complication rates.
RESULTS
Mean age was 9 years (3–16) and mean weight was 30 kg (15–55). Mean set-up time, from
skin incision until the end of docking, was 1 hour (47–82 min). Mean surgeon’s console time was
169 min (108–300). No conversion to an open operation was necessary. The postoperative course
was free of complications. All the patients but one were discharged on day one. Mean follow-up was
6 months (1–10). Redo pyeloplasty was not needed. Transmission to trainees was feasible only
after 10 cases done by the same surgeon.
CONCLUSIONS
These early results suggest that retroperitoneal RALP in children is feasible, safe and effective;
a longer term follow-up is awaited.