ESPU Meeting on Thursday 20, April 2023, 16:20 - 17:05
16:20 - 16:23
S13-1 (OP)
Daniel CABEZALÍ, Cristina TORDABLE, Cecilia CASTELLANO and Andres GOMEZ
Hospital 12 de Octubre, Pediatric Surgery. Urology section, Madrid, SPAIN
PURPOSE
The aim of this study is to evaluate the effect of 3 dimensional system ( 3D) in the operative time and complications during a laparoscopic pyeloplasty procedure ( LP) compared to 2 dimensional ( 2D) laparoscopy.
MATERIAL AND METHODS
We prospective evaluated 54 children that underwent LP with 2D ( 28 patients) and 3 D system ( 26 patients) . The surgical procedure was divided in steps ( dissection, posterior wall ureteropelvic suture, catheter placement, anterior wall ureteropelvic suture and pelvic-pelvic suture) and patients were randomly assigned to both groups.
These surgical steps times, complications and hospital stay were analyzed and compared between 2D and 3D groups.
RESULTS
The mean total operative time was 58.50 minutes in 2DLP group and 47,5 in 3DLP ( p< 0.05). The mean time of the surgery steps was: dissection 23.50 minutes in the 2DLP and 15.00 in the 3DLP ( p<0,05); posterior wall ureteropelvic suture 16.00 in the 2DLP group and 14.00 in 3DLP; catheter placement 5.50 in the 2DLP group and 3.00 in the 3DLP ( p< 0,05); anterior wall ureteropelvic suture 10.00 in the 2DLP and 8.00 in the 3DLP ( p < 0.04); pelvic-pelvic suture 6.50 in the 2DLP and 5.00 in the 3DLP.
The average hospital stay was 1,3 days in the 2DLP and 1,2 in the 3DLP ( p >0,05) and there were no complications in any group.
CONCLUSIONS
3DLP improves the operative time, mainly the dissection, the catheter placement and the anterior wall ureteropelvic suture but there are no significant differences in the posterior wall ureteropelvic suture, complications and hospital stay.
16:23 - 16:26
S13-2 (OP)
Bruno CEZARINO, Francisco DENES, Roberto IGLESIAS and Marcos MACHADO
Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Urology - Pediatric Urology, Sao Paulo, BRAZIL
PURPOSE
Introduction:Minimally invasive surgery is a reality treating patients with pieloureteral stenosis. Usual apposition of the trocars still follows Clayman's classic description: except for the umbilical scar, the other laparoscopic portals are exposed in the abdomen. With the advances in laparoscopic skills and the application of robotic surgery in pediatric urology, hidden incision endoscopic surgery (HidES) has been introduced to obtain a better final cosmetic aspect with the scars located intraumbilically and in the hypogastric region.Objectives: 1. evaluate safety and efficacy of the alternative technique in improving the cosmetic aspect. 2. Compare a new technique with the classic laparoscopic pyeloplasty series to assess non-inferiority outcomes.
MATERIAL AND METHODS
24 pediatric patients who underwent HidES pyeloplasty were prospectively assessed and compared to a prospective cohort of 109 traditional port pyeloplasty in terms of gender, median age, weight, laterality, SFU grade hydronephosis and split renal function. Bleeding, operative time, hospital stay, narcotic use, and postoperative complications were compared between groups.
RESULTS
Results: Groups were comparable regarding preoperative characteristics. There were no conversions to the classic or open techniques in the patients analyzed in both groups. No statistical differences were noted related to operative time, bleeding or success rate. There were no intraoperative complications neithercomplications above Clavien-Dindo II during the 6-week follow-up.
|
Population |
TPP |
HiDEs |
p |
|
Age (mo) |
57.2 |
62.1 |
NS |
|
Weight (kg) |
22 |
26 |
NS |
|
SFU hydro |
3,1 |
3,4 |
NS |
|
Outcomes |
TPP |
HiDEs |
p |
|
Operative Time (min) |
78 |
96 |
NS |
|
Admission time (hrs) |
17.5 |
26 |
NS |
|
Narcotic use (MED) |
0 |
0 |
NS |
|
Complications (Clavien III-IV) |
1 |
1 |
NS |
|
conversions |
0 |
0 |
NS |
CONCLUSIONS
Conclusions: The technique of aesthetic apposition of ports in pyeloplasty proved to be safe, viable, reproducible and not inferior to the traditional positioning of portals. This technique can benefit the patients’ final cosmetic result.
16:26 - 16:29
S13-3 (OP)
Gabriel MOLINEROS 1, Ofer GOFRIT 1, Mordechai DUVDEVANI 1, Ezekiel LANDAU 1 and Guy HIDAS 2
1) Hadassah and Hebrew University Medical Center, Urology, Jerusalem, ISRAEL - 2) Hadassah and Hebrew University Medical Center, Pediatric Urology, Jerusalem, ISRAEL
PURPOSE
Robotic surgeries have been proven to be safe and effective in pediatric urology. The surgical scar appearance is of great influence on the decisions of the patient and family prior to surgery. Robotic surgery is usually assumed to have a cosmetic advantage over open surgery because the scars are smaller, but do patients and parents really prefer these scars? we aimed to answer this question.
MATERIAL AND METHODS
An online survey was distributed by social media. In the questionnaire three cartoon pictures of individuals with different incisional scars were shown. The respondents were asked to choose between two pictures and answer the following question: In case you(or your child) were to have surgery, which scar would you prefer? first picture showed dorsal-lumbotomy or laparoscopic/robotic kidney surgery incisions. Second picture flank or laparoscopic/robotic kidney surgery incisions, and third Pfannenstiel incision or laparoscopic/robotic bladder surgery incisions.
RESULTS
750 persons participated in the study, 74% female, average age 41.3 years. For the first question 65% of respondents preferred dorsal lumbotomy, 22% laparoscopic/robotic, 13% no preference. For the second question 74% preferred laparoscopic/robotic incisions, 18% flank incision and 8% no preference. for the third question 48% preferred laparoscopic/robotic bladder surgery incisions, 44% Pfannenstiel and 8% no preference.
CONCLUSIONS
Dorsal lumbotomy incision is superior to robotic/laparoscopic approach by most responders. Robotic/laparoscopic approach is superior to flank approach. For bladder surgical scars, about half of responders prefer the Pfannenstiel approach. Since appearance of scars has a great influence on the decision making, it should be discussed when presenting surgical options.
16:40 - 16:43
S13-4 (OP)
Sean W. HOU 1, Monica H. XING 1, Parviz HAJIYEV 2, Alyssa LOMBARDO 1, Amrita MOHANTY 1 and Mohan S. GUNDETI 3
1) University of Chicago, Pritzker School of Medicine, Chicago, USA - 2) University of Chicago, Department of Surgery, Section of Urology, Chicago, USA - 3) University of Chicago, Department of Surgery, Section of Urology, Comer Children's Hospital, Chicago, USA
PURPOSE
Augmentation cystoplasty (AC) is conventionally performed as open surgery, which remains the gold standard surgical approach. The objective of our study was to determine whether there is a difference in perioperative and 30- and 90-day postoperative outcomes in pediatric patients who underwent open augmentation ileocystoplasty (OAI) versus robotic-assisted laparoscopic ileocystoplasty (RALI) at our institution.
MATERIAL AND METHODS
We retrospectively reviewed electronic medical records of 45 pediatric patients who underwent AC and concomitant reconstructive procedures for neurogenic bladder and bowel under a single surgeon between 2008 to 2021. 30- and 90-day postoperative complications, defined as direct complications of the surgery, were graded with the Clavien-Dindo grade (CDG) classification system. The highest CDG was assigned for patients with multiple complications. Patients converted from robotic to open surgery were accounted for by intention-to-treat analysis.
RESULTS
The cohort consisted of 19 and 26 patients in the open and robotic groups, respectively. Two patients were converted from robotic to open surgery. Overall success rates, defined as no redo augmentation or removal of the augmented bladder, were similar between the two groups (90.5% open, 100% robotic, p = 0.12). While median operative time was greater for the robotic cohort (p < 0.001), median length of stay, estimated blood loss, and PODs to return to a regular diet were comparable between groups (Table 1). Comparable rates of 30- and 90-day CDG I-III postoperative complications were observed between groups (Table 1).
CONCLUSIONS
In this case series, we show that RALI is a feasible approach that has comparable functional outcomes to OAI. To our knowledge, this serves as the largest patient cohort and longest follow-up period of any study of pediatric RALI versus OAI to-date. Further refinements to operative technique to reduce operative time and cost-analysis are necessary to further substantiate the benefits of RALI.
16:43 - 16:46
S13-5 (OP)
Santiago WELLER, Juan Pablo CORBETTA, Javier RUIZ, Nicolas ROSIERE, Cristian SAGER, Carola BUREK, Felicitas LOPEZ IMIZCOZ, Esteban GALLINO, Yesica GOMEZ, Luciana DIAZ ZABALA and Otilia BLAIN
Garrahan Hospital, Urology, Ciudad Autonoma Buenos Aires, ARGENTINA
PURPOSE
Clean intermittent catheterization via a Mitrofanoff channel has revolutionized the management of neurogenic bladder patients. Different modifications and approaches have been described for this technique during the last decades. Our objective is to compare and analyze long-term outcomes and morbidity of three different approaches for Mitrofanoff channel creation.
MATERIAL AND METHODS
A retrospective cohort study was performed of all children who underwent open (O), laparoscopic assisted (LA)or laparoscopic (L) Mitrofanoff channel at a single institution from July 2007 to January 2021. Patients with voiding dysfunction and indication of clean intermittent catheterization who did not require concomitant procedures with a minimum 12-month period follow up where include in the cohort.
RESULTS
Sixty-one patients (O=20, LA=24, L=17) were include with a median age 119 months (r 45-204) and median follow up 41.9 months (r 12-149). Mean operative time was 132 min for the open group versus 157 min and 201 min for LA and L groups respectively (p = 0.0001). Mean hospitalization was shorter in O vs L and LA (4.6 vs 6.3 and 4.8, p 0.027). No differences were found between the three groups in term of short-term and infra-aponeurotic complications. Supra-aponeurotic stenosis was more common in laparoscopic group (p 0.041). History of previous abdominal surgeries was a risk factor of long-term complications (OR 3.84).
CONCLUSIONS
Conventional open Mitrofanoff procedure continues showing better outcomes in term of operative time, hospital stay and complications in comparison with minimally invasive approaches.
16:46 - 16:49
S13-6 (OP)
Kiarash TAGHAVI 1, Venusia FIORENZA 2, Mariana CORNET 2, Mathilde GLENISSON 2, Nicolas VINIT 2, Sabine SARNACKI 2 and Thomas BLANC 2
1) Monash Children's Hospital, Department of Paediatric Urology, Melbourne, AUSTRALIA - 2) Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, FRANCE
PURPOSE
Minimally invasive surgery for adrenal tumours in children have undergone iterative
broadening of indications and approaches. However, robot-assisted adrenalectomy (RAA) in children
remains poorly studied. The current prospective study aims to demonstrate the feasibility, safety and
efficacy of RAA in treating children with neuroblastic and endocrine adrenal tumours. This represents
the largest experience in the literature to date.
MATERIAL AND METHODS
A prospective institutional analysis of children presenting with neuroblastic and endocrine
tumours treated with RAA was undertaken over a five year-period. For each child, clinical parameters
collected were: presentation, diagnostic work-up, surgical management, pathology and outcomes.
RESULTS
During the study period 38 RAA were performed; 20 for neuroblastic tumours (90% of which
were neuroblastomas) and 18 for endocrine tumours. Seven neuroblastic tumours (35%) had image-
defined risk factors (all due to tumour contacting the renal pedicle), and 11 (55%) had high-risk
disease. One child underwent a synchronous planned nephrectomy due to significant tumour
infiltration into renal parenchyma and hilum. Median length of stay was 2 days. Resection margins
were macroscopically clear in all cases. After a mean follow-up of 2.2 years, there have been no
deaths, and two high-risk children had metastatic relapse of neuroblastoma. Eleven children
underwent RAA for endocrine tumours: pheochromocytoma, or hypercortisolism in the context of
genetic predisposition syndromes. One child required non-emergent conversion, and one
complication occurred (grade 3b).
CONCLUSIONS
The current study affirms the feasibility, safety and effectiveness of RAA in selected
children, through an iterative process and in the setting of a dedicated paediatric robotic surgical team.
Precise surgical dissection and the freedom of movement provided by the robotic platform has
allowed increasingly complex cases to be undertaken (e.g. selected positive IDRFs, large tumours, genetic
predisposition syndrome).
16:49 - 16:54
S13-7 (VP)
Caroline JAMAER, Jolien VANDERJEUGT, Ellen VANDAMME, Erik VAN LAECKE, Piet HOEBEKE and Anne-Françoise SPINOIT
Ghent University Hospital, Urology, Ghent, BELGIUM
PURPOSE
The fascia sling is a standard validated treatment for isolated stress-incontinence especially in those young patients presenting with a wide open bladder neck, and in whom mesh material is best avoided. This video demonstrates the robot-assisted approach in one patient, as illustration of the technique.
MATERIAL AND METHODS
The robot-assisted approach for fascia sling is demonstrated step by step in a 21 year-old female. She was referred for isolated stress-incontinence refractory to physiotherapy. The complaints existed since childhood and worsened in recent years. A video-urodynamic investigation showed incontinence during Valsalva without detrusor overactivity. She presented a wide bladder neck, but no further anatomical variations.
The patient is installed in lithotomy position, allowing vaginal acces. A bladder catheter is placed, permitting inflation and deflation of the bladder and performance of leak tests. Initial assessment of efficacity of the surgery is therefore per-operatively performed. Three trocars are placed, with initial placement of the first trocar in the umbilicus through Hasson technique. The Intuitive Da Vinci Xi platformed is used. Trendelenburg position of 25 degrees is applied. The retropubic space is opened and the urethra and bladder are exposed. The fascia sling is created from the inner rectus abdominis muscle fascia sheet and tunneled under the urethra. Subsequently the sling is fixed to the pubic bone so the urethra and bladder neck are suspended. Leak test is performed when suspension of the sling is realized.
RESULTS
Patient keeps the bladder catheter for 24 hours, and remains one night in the hospital. Blood loss is minimal and a surgical time of 125 minutes si standard. No post-operative complications are noted to date. Complete resolution of the urinary incontinence is noted with a minimum follow-up of 1 year.
CONCLUSIONS
A robot-assisted fascia sling is a valid treatment for stress incontinence in young female patients, especially when a wide bladder neck is visualized.