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11–14 APRIL, 2018, HELSINKI, FINLAND
09:28–09:31
S14-8 (PP)
ROBOTIC SURGERY IN PEDIATRIC UROLOGY:
5 MM INSTRUMENTS ARE SAFE FOR PEDIATRIC
UROLOGIC RECONSTRUCTIVE PROCEDURES
Trudy KAWAL, Aseem SHUKLA, David CHU, Yves BODAR and Arun SRINIVASAN
Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
The aim of this study is to examine the overall experience at a single pediatric urology center using
5 mm instruments with no planned additional assistant ports during common robotic procedures.
We hypothesized this approach is safe and feasible for a variety of pediatric urologic reconstructive
procedures.
MATERIAL AND METHODS
We retrospectively reviewed all major robotic procedures entered into an IRB approved data registry.
The analysis was performed only for procedures in which 5 mm instruments were used exclusively
with hook diathermy. Procedures that utilized 8 mm instrumentation were excluded from the study.
Data were abstracted according to patient age, weight and robotic surgery performed. Outcomes
included post-operative complications, operative time, operative blood loss, need for assistant port
placement and conversion rates to open or laparoscopic surgery.
RESULTS
From 2012 to 2016, 220 consecutive pediatric RAL urological surgical cases were performed on
201 patients. These comprised pyeloplasty (n=102) 46.4 %, ureteral reimplants (n=84) 38.2 %
and ipsitateral ureteroureterostomy (n=34) 15.5 %. Median age at surgery was 4 years (3 months
to 18 years). There were no conversions to open or laparoscopic surgery. Placement of an ad-
ditional Assist port was documented in 7 cases. Severe (Clavien grade 4) complications occurred
in 2 patients requiring ICU admission: one for sepsis and one ventilator dependent patient having
increased work of breathing post op. Intra-op blood loss was minimal (<50 ml) in 97 % of cases.
Patients ≤ 1 year of age comprised 28.6 % of the study population. Univariate analysis revealed no
association between age and occurrence of complications (p=0.957)
CONCLUSIONS
This study represents one of the largest series of consecutive robotic assisted laparoscopic surgery
using 5 mm instruments in pediatric urology. We conclude that the use of 5 mm instruments gives
excellent operative outcomes in pediatric reconstructive procedures.