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Upper or lower tract approach for duplex anomalies? A bi-institutional comparative analysis of robot-assisted approaches

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Abstract

Optimal management of duplication anomalies may include an upper or lower tract surgical approach. In the contemporary era, the robot-assisted laparoscopic heminephrectomy (RALHN) and robot-assisted laparoscopic ipsilateral ureteroureterostomy (RALIUU) are viable interventions predicated on clinical, institutional and surgeon preferences. We present a multi-institutional comparative analysis aiming to compare the outcomes of RALHN and RALIUU to see if either of the approaches confers an advantage over the other in treating duplex renal anomalies needing intervention. We completed a retrospective review of consecutive children undergoing RALIUU at Hospital A and RALHN at Hospital B from January 2009 to March 2017. The primary outcome was ‘surgical success’ defined by the resolution of clinical symptoms, improved radiological parameters, and no unplanned subsequent interventions till the time of study completion. Secondary outcomes included operative parameters, complications, and subsequent urinary infections. There were 39 RALIUU and 28 RALHN. Baseline demographic and clinical parameters across two cohorts were similar. The primary outcome of ‘surgical success’ was 100% across both cohorts. There were no major surgical complications, and the incidence of postoperative urinary tract infection was minimal and similar for both groups. Operative time favored RALHN; blood loss and analgesic requirements were minimal in both cohorts. Both RALIUU and RALHN are definitive surgical interventions in children with complex duplex moieties, delivering satisfactory surgical outcomes with a low complication profile and marginal differences in the postoperative patient outcomes. This pilot bi-institutional study provides the basis for a larger collaboration to further define optimal techniques, standardize surgical care pathways, and interrogate long-term outcomes.

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Funding

No funding was received for this article. No competing financial interests or non-financial conflicts exist. The authors RS, MVR, TK, NB, AKS, MG and ARS declare that they have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Pediatric Urology, Children’s Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA

    Ravindra Sahadev & Trudy Kawal

  2. Pediatric Urology, University of Chicago Medicine Comer Children’s Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA

    Maria Veronica Rodriguez & Nimrod Barashi

  3. Children’s Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA

    Arun K. Srinivasan & Aseem R. Shukla

  4. University of Chicago Medicine Comer Children’s Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA

    Mohan Gundeti

Authors
  1. Ravindra Sahadev
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  2. Maria Veronica Rodriguez
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  3. Trudy Kawal
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  4. Nimrod Barashi
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  5. Arun K. Srinivasan
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  6. Mohan Gundeti
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  7. Aseem R. Shukla
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Contributions

Drs. ARS, MG and AKS conceived the research question and designed the study. They revised the manuscript critically for important intellectual content and approved final draft. Drs. RS, MVR, TK, and NB were involved in the data abstraction, communications, statistical analysis and preparation of the manuscript. Together all the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Ravindra Sahadev.

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The research findings were presented in the annual meeting of Society for Pediatric Urology, American Urologic Association, Chicago, May 2019.

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Sahadev, R., Rodriguez, M.V., Kawal, T. et al. Upper or lower tract approach for duplex anomalies? A bi-institutional comparative analysis of robot-assisted approaches. J Robotic Surg 16, 1321–1328 (2022). https://doi.org/10.1007/s11701-022-01372-2

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  • DOI: https://doi.org/10.1007/s11701-022-01372-2

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