Robot-assisted pyeloplasty in children – the first series of patient treatment

• Yury А. Kozlov
• Simon S. Poloyan
• Sapukhin E.V.
• Strashinsky A.S.
• Makarochkina M.V.
• Marchuk A.A.
• Rozhansky A.P.
• Byrgazov A.A.
• Muravyev S.A.
• Narkevich A.N.

Abstract

This study demonstrates the first series of treatment for children with pyeloureteral junction obstruction who underwent robot-assisted pyeloplasty using the new generation Versius robotic platform manufactured by CMR (UK).

Material and methods. The study presents retrospective data on all patients with pyeloureteral segment obstruction operated on using robot-assisted technology at the Irkutsk State Regional Children’s Clinical Hospital. The diagnosis of hydronephrosis was established by ultrasound examination of the kidneys, as well as multislice computed tomography data with intravenous administration of a contrast agent. Indications for surgery were established on the basis of determining the anteroposterior diameter of the pelvis, exceeding 20 mm, reducing the thickness of the kidney parenchyma by less than 1/2 compared to a healthy kidney. Anderson–Hynes transperitoneal robot-assisted pyeloplasty was used. To perform the procedure, a new generation robot platform Versius (manufacturer CMR, UK) was used.

Results. The median age of patients was 9,9±3.7 years (median 10.5 [7.0; 11.8] years). The ratio of male and female patients was 6/2 (67/33%). The side of the lesion was represented by a ratio of 4/4 (50/50%). The size of the pelvis before surgery was 34,3±13,1 mm (median 29.0 [25.0; 38.5] mm). The duration of the operation was 160.6±44.0 minute (median 150.0 [128.8; 196.3] minutes). Surgical interventions were not accompanied by intraoperative complications. All robot-assisted surgeries were performed without conversion to laparoscopic or open procedures. The average duration of stay in the intensive care unit was 18.6±2.0 hours (median 19.0 [16.9; 19.6] hours). The median duration of hospital stay was 6.3±1.0 days (median 6.5 [6.0; 7.0] days). Ultrasound examination performed 3 months after the operation showed a statistically significant decrease in the anteroposterior diameter of the pelvis to 9.0±3.2 mm (median 8.0 [8.0; 9.3] mm). All patients demonstrated the absence of early (urinoma) and late (relapse, loss of kidney function) complications.

Conclusion. Robot-assisted pyeloplasty is safe and effective when used in children. The emergence of new robotic platforms such as Versius could further expand the use of robotic-assisted pyeloplasty in children.

Keywords:robot-assisted surgery; pyeloureteral segment obstruction; hydronephrosis; children

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