MP52-07 DOES THE USE OF 5 MM INSTRUMENTS AFFECT THE OUTCOMES OF ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY IN SMALLER WORKING SPACES? A COMPARATIVE ANALYSIS OF INFANTS AND OLDER CHILDREN

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2017MP52-07 DOES THE USE OF 5 MM INSTRUMENTS AFFECT THE OUTCOMES OF ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY IN SMALLER WORKING SPACES? A COMPARATIVE ANALYSIS OF INFANTS AND OLDER CHILDREN Minki Baek, M. Selcuk Silay, Jason Au, Gene Huang, Abhishek Seth, Nicolette Janzen, David Roth, and Chester Koh Minki BaekMinki Baek More articles by this author , M. Selcuk SilayM. Selcuk Silay More articles by this author , Jason AuJason Au More articles by this author , Gene HuangGene Huang More articles by this author , Abhishek SethAbhishek Seth More articles by this author , Nicolette JanzenNicolette Janzen More articles by this author , David RothDavid Roth More articles by this author , and Chester KohChester Koh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1637AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pediatric robot-assisted laparoscopic (RAL) pyeloplasty has become a viable minimally invasive surgical option for ureteropelvic junction obstruction (UPJO) with several previous reports on its efficacy and safety. However, RAL pyeloplasty in infants can be a challenging procedure due to the smaller working spaces, and the use of the larger 8 mm instruments for these patients instead of the 5 mm instruments is common due to the shorter wrist lengths. We hypothesized that the use of 5 mm instruments for RAL pyeloplasty in infants with smaller working spaces will not affect the perioperative parameters and surgical outcomes in comparison to older children with larger working spaces. METHODS We compared the perioperative parameters and surgical outcomes of RAL pyeloplasties performed by a single surgeon in infants and non-infant pediatric patients over a 2 year period using an 8.5 mm camera and 5 mm robotic instruments. Patient demographics, operative times, intra- and post- operative complications, hospital pain medication usage, hospital length of stay, and treatment success rates were compared between the two groups. RESULTS A total of 65 pediatric RAL pyeloplasties were included in the study (16 infants and 49 non-infant pyeloplasties). There were no significant differences in gender, laterality, proportion of re-do pyeloplasty, or preoperative hydronephrosis grade between the two groups. All procedures were performed without conversion to open surgery or significant perioperative complications. There were no differences in segmental operative times (total operative time, console time, port placement time, time for dissection to UPJO, and anastomosis time), hospital pain medication usage, and hospital length of stay between the two groups (p > 0.05 for all comparisons). The treatment success rates were 93.8% (15/16) and 100% (49/49), respectively (p = 0.08). CONCLUSIONS RAL pyeloplasty is a safe and effective surgical modality even in infants with comparable perioperative parameters and outcomes as those in older children. The use of 5 mm instruments in infants with smaller working spaces does not affect these parameters as well, while offering the potential for improved cosmesis. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e705-e706 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Minki Baek More articles by this author M. Selcuk Silay More articles by this author Jason Au More articles by this author Gene Huang More articles by this author Abhishek Seth More articles by this author Nicolette Janzen More articles by this author David Roth More articles by this author Chester Koh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...