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JU Insight: Outpatient Robotic Surgery in Pediatric Urology: Assessment of Feasibility and Short-Term Safety
By: Amos Neheman, MD; Eyal Kord, MD, MPH; Brian A. VanderBrink, MD; Eugene A. Minevich, MD; Paul H. Noh, MD | Posted on: 01 Apr 2022
Neheman A, Kord E, Vander Brink BA et al: Outpatient robotic surgery in pediatric urology: assessment of feasibility and short-term safety. J Urol 2021; https://doi.org/10.1097/JU.0000000000002362.
Study Need and Importance
With a growing body of evidence indicating that robotic surgery for pediatric urological conditions can be performed in an outpatient setting, we aimed to assess the short-term safety and feasibility of robotic reconstructive and extirpative surgery in children as scheduled outpatient procedures. We describe the largest cohort of pediatric patients undergoing outpatient robotic urological surgery thus far. This study can help inform physicians and patients regarding the feasibility of such surgeries and help implement outpatient robotic programs.
Table. Demographic data of patients undergoing outpatient robotic surgery
| Robotic Assisted Laparoscopic Ureteral Reimplantation | Robotic Assisted Laparoscopic Pyeloplasty | Robotic Assisted Laparoscopic Nephrectomy/Hemi-Nephrectomy/Nephroureterectomy/Other | Robotic Assisted Laparoscopic Ipsilat Ureteroureterostomy | |
|---|---|---|---|---|
| No. pts | 55 | 62 | 8 | 10 |
| Median mos age (IQR) | 68 (47–90) | 41 (11–102) | 42 (20–156) | 75 (43–115) |
| Median kg wt (IQR) | 21 (16–28) | 16 (10–30) | 15 (12–51) | 25 (17–31) |
| Median kg/m2 body mass index (IQR) | 16 (15–17) | 17 (15–18) | 17 (16–21) | 16 (15–18) |
| Laterality (rt/lt) | 28/27 | 25/37 | 4/2 | 4/6 |
| Gender (male/female) | 13/42 | 44/18 | 5/3 | 6/4 |
What We Found
We describe the perioperative outcomes, rates of 30-day complications, emergency room (ER) visits and readmissions in a cohort of 135 pediatric patients who underwent outpatient robotic surgery from June 2012 to December 2019. In our cohort, the majority of patients underwent pyeloplasty (62) or extravesical ureteral reimplantation (55; see table). Ten patients underwent extirpative procedures (nephrectomy, partial nephrectomy) and 8 patients underwent ureteroureterostomy. During the 30-day followup period there were 9 complications (6.7%), of which only 1 (0.7%) was high grade (Clavien-Dindo 3). There were 9 ER visits (6.7%) including 5 cases of readmission (3.7%). Our study shows that robotic reconstructive and extirpative procedures in pediatric urology can be safely performed as scheduled outpatient procedures in the majority of patients, obviating the need for routine inpatient care.
Limitations
This study is limited by the performance of surgery by 2 surgeons, potentially limiting generalizability, and a short-term assessment of outcomes as our goal was to establish safety and feasibility.
Interpretation for Patient Care
This study supports the feasibility of pediatric urological outpatient robotic surgery. Implementation of such programs may help to minimize intervention, allow the patients to quickly return to their routine and diminish the risks of exposures that exist in an inpatient setting.