Background: With its three-dimensional, enhanced (10x) vision and greater degree of rotational movement allowing improved suture re-approximation of tissue, robotic-assisted laparoscopic surgery has gained increased popularity in reconstructive surgery. In this study, we evaluated our early experience using the da Vinci robotic system in performing robotic assisted laparoscopic surgery (RALS) in children with ureteral obstruction and duplication anomalies.
Methods: Between April 2004 and December 2005, seven children (mean age 7.4 years (0.7 - 14.3)) with obstructive ureteral anomalies underwent robotic-assisted transperitoneal laparoscopic reconstruction. Surgeries included: ureteroureterostomy; lower pole pyeloplasty; and upper pole to lower pole pyeloureterostomy. Double J stents were used in all but one case. Operative time, perioperative complications, analgesic needs, length of stay, and success rate were evaluated. Follow-up radiologic evaluations were performed at 2.0 to 14.6 months after surgery (mean 6.5 months).
Results: The mean operative time was 198.6 minutes (145 - 244 minutes) with average estimated blood loss of 15 cc (10-20 cc). There were no intraoperative or postoperative complications. The average length of hospitalization was 2.5 days (1 - 4.3 days). The average total narcotic usage was 1.6 mg/kg of morphine. Post-operative radiographic imaging demonstrated improvement and/or resolution of hydronephrosis in all cases. All children were asymptomatic at most recent follow up.
Conclusions: Although uncommon, obstructive ureteral anomalies in duplicated systems can be treated using RALS safely and with favorable results. This approach seems particularly advantageous for the older child. Operative time and analgesic needs are comparable to those reported for other conventional or robotic-assisted laparoscopic procedures.