ESPU Meeting on Thursday 18, April 2024, 17:35 - 18:15
17:35 - 17:38
S13-1 (OP)
Nina MARTZ 1, Amane-Allah LACHKAR 1, Jean BREAUD 2, Liza ALI 1, Isabelle TALON 3, François BECMEUR 3, Alaa EL GHONEIMI 1, Valeska BIDAULT-JOURDAINNE 4 and Matthieu PEYCELON 1
1) Department of Pediatric Surgery and Urology, University hospital Robert-Debré, Université Paris Cité, National reference center for rare urinary tract malformations (MARVU), Paris, FRANCE - 2) Department of Pediatric Surgery, Hôpital Universitaire Pédiatrique Lenval, Fondation Lenval Pour Enfants, Nice, FRANCE - 3) Department of Pediatric Surgery, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, FRANCE - 4) Department of Pediatric Surgery and Urology, Hôpital Femme Mère Enfant, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, FRANCE
PURPOSE
This study aimed to explore whether positive or negative comments on trainees in pediatric urology had an impact on performance during simulation in pediatric laparoscopy.
MATERIAL AND METHODS
Twenty-five students enrolled in a national Pediatric Urology Laparoscopy Simulation Program performed the Fundamentals of Laparoscopic Surgery (FLS) skills using plot-transfer and intracorporeal knot-tying in a randomized study design while under the positive or negative feedback of an attending pediatric urologist. On the first day, all students performed FLS plot-transfer and intracorporeal knot-tying on a pediatric laparoscopic simulator. On the second day, students were randomized and performed FLS tasks with positive or negative comments during the procedure. Task performances, evaluated by task time and errors, were compared between both groups. Statistical analysis: Mann-Whitney U test.
RESULTS
Difference in execution time between exercises with and without feedback was greater in the group that received negative feedback compared to the group that received positive feedback (p=0.003). Students who received positive feedback decreased their time by a median of one second while students who received negative comments increased their time by a median of twenty-three seconds.
CONCLUSIONS
Feedback should be delivered in a manner that is supportive, respectful, and focused on improvement rather than discouragement. Understanding these dynamics can inform the development of effective feedback strategies to optimize learning and to improve performance outcomes in training for minimally invasive surgery in pediatric urology.
17:38 - 17:41
S13-2 (OP)
Benjamin WHITTAM 1, Rosalia MISSERI 2, Joshua ROTH 2, Konrad SZYMANSKI 2, Mark CAIN 2, Richard RINK 2 and William BENNETT 1
1) Riley Hospital for Children at IU Health, Pediatric Urology, Indianapolis, USA - 2) Riley Hospital for Children at IU Health, Indianapolis, USA
PURPOSE
Robot assisted laparoscopic (RAL) surgery continues to gain popularity among pediatric surgical specialists, particularly for reconstructive procedures such as correction of ureteropelvic junction obstruction (UPJO). Despite excellent clinical outcomes with the open approach, many pediatric urologists are shifting towards newer RAL approaches in the absence of evidence from blinded randomized controlled trials (RCTs). We designed a pilot comparative effectiveness trial of open versus RAL pyeloplasty in pediatric patients.
MATERIAL AND METHODS
Non-obese (<95th% BMI for age) patients age 2 - 8 years old diagnosed with a UPJO were approached by a research assistant regarding enrollment into the RCT. Upon signing consent, patients were randomized to OP or RALP and scheduled for surgery. Patients, families and nursing staff were blinded as to the approach used for the first 24 hours postoperatively. Primary outcomes were ability to randomization patients and effectiveness of blinding to randomization.
RESULTS
Over a 16 month period, 11 patients met inclusion criteria and 10 agreed to randomization (91%): 5 underwent open pyeloplasty and 5 robotic pyeloplasty. All patients were symptomatic with flank pain and associated nausea/vomiting. Mean age was 5.4 years, 7 were male, had an average BMI of 16.7kg/m2 and UPJO was on the right in 4 patients. On exit interview at 24 hours after surgery, blinding was deemed adequate by families and nursing staff, with 40% of nurses and families correctly identifying the procedure. There were no intraoperative complication and one 30 day Clavien Dindo 3b complication (a stent removal in the operating room in robotic cohort secondary to internal migration of his extraction string). At last follow-up, all patients remained asymptomatic with stable or improved hydronephrosis.
CONCLUSIONS
We successfully randomized and blinded 10 children to undergo either open or robotic surgery. Using current recruitment strategy and expanding inclusion criteria, we are planning a multi-institutional comparative effectiveness trial comparing open to robotic pyeloplasty in the pediatric population.
17:41 - 17:44
S13-3 (OP)
Nicolas FERNANDEZ 1, Diboro KANABOLO 2, Jennifer AHN 2, Paul MERGUERIAN 2 and Daniel LOW 2
1) Seattle Childrens Hospital - University, Urology, Seattle, USA - 2) Seattle Childrens Hospital - University, Seattle, USA
PURPOSE
Introduction:
Adaptation to high surgical demand has placed a premium value on operating room efficiency.
Our aim was to reduce operative time, by reducing total console time in robot assisted pyeloplasty (RP) cases. We hypothesized that process improvement and supply management during RP leads to a significant reduction in operative time.
MATERIAL AND METHODS
Methods:
We chose a family of measures to determine improvement. These included robotic arm activity, and total operative time. Interventions included: standardized OR staff tasks, a priori supply inventory procurement. Baseline RP duration was recorded before any interventions. Intraoperative surgical workflow was reviewed, and routine tasks performed were selected. A clinical standard work (CSW) was developed based on optimization of equipment/supplies. Balancing measures included percentage trainee console use, and OR block start/end time. Baseline data for RP cases performed between 11/2020 and 2/2022 were automatically extracted and analyzed using AdaptX (Seattle, WA).
RESULTS
Results:
Thirty-seven patients underwent RP during the study period. Fifteen cases were performed prior and 22 post intervention. Total console time prior to intervention was 152 vs 109 mins after intervention (p=0.0002). Dual instrument inactivity was reduced from 13.1% to 7.1% (p<0.0001). Dual consoles were used in 40% vs ~69% pre- vs post- intervention, respectively (p=0.5000). No difference in patient age distribution between groups was seen (p=0.1498). Trainee operative time did not differ statistically pre- and post-intervention (63.0 vs 48.6%, p=0.0871).
CONCLUSIONS
Conclusions:
Decreasing surgical lapses and standardizing intraoperative tasks can consistently facilitate more efficient case completion and increase OR capacity.
17:55 - 17:58
S13-4 (OP)
Sang Hoon SONG, Jaeyoung CHO, Kyunghyun NAM, Homin KANG and Kun Suk KIM
Asan Medical Center, University of Ulsan College of Medicine, Department of Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
We aimed to examine the impact of surgical technique modifications on the success of robotic extravesical ureteral reimplantation.
MATERIAL AND METHODS
We retrospectively evaluated patients undergoing robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) for vesicoureteral reflux between July 2013 and February 2023. A key technical modification was introduced in June 2021, which involved including ureteral adventitia in detrusorraphy and introducing a robust distal end detrusorraphy suture as the first suture. We classified patients into Groups 1 and 2 based on the timing of their surgeries relative to this modifications. Success was evaluated by the radiographic resolution of VUR.
RESULTS
The study included 67 pediatric patients, representing 105 ureteral units: 61 in Group 1 and 44 in Group 2. On average, patients underwent RALUR-EV at 48 months, with a 5.5 months follow-up. Both groups showed similar VUR grades preoperatively. Operation duration was notably different, with Group 1 averaging 167 minutes and Group 2 at 145 minutes (p<0.001). The success rate increased from 75.4% in Group 1 to 95.5% in Group 2 with the new technique (p=0.006). The 30-day complications were similar between groups: grade I at 19.7% and grade II at 18.0% for Group 1, compared to 14.3% and 9.5% for Group 2.
CONCLUSIONS
The synergistic impact of ureteral adventitia inclusion in detrusorraphy and robust distal end detrusorraphy suture as the first detrusorraphy suture significantly improved the success rate of robotic extravesical ureteral reimplantation. This modified technique provides a promising strategy to improve patient outcomes without exacerbating postoperative complications in managing vesicoureteral reflux.
17:58 - 18:03
S13-5 (VP)
Inge VAN DE CAVEYE 1, Joris VANGENEUGDEN 1, Piet HOEBEKE 1, Caroline JAMAER 2 and Anne-Francoise SPINOIT 1
1) Ghent University Hospital, Urology, Gent, BELGIUM - 2) Jessa Hasselt, Urology, Hasselt, BELGIUM
INTRODUCTION
The trans-appendicular continent cystostomy was first described by Mitrofanoff in 1980 (1). Its adaptation for the robot-assisted approach is illustrated step by step in this video.
1. Mitrofanoff P. Trans-appendicular continent cystostomy in the management of the neurogenic bladder. Chir Pediatr. 1980;21:297-305.
PATIENTS AND METHODS
We report our experience in a robot-assisted Mitrofanoff procedure in children. The technique is illustrated in a 7-year-old boy with a history of posterior urethral valves evolving into an atonic bladder.
RESULTS
The patient was positioned in a classical robot-adapted lithotomy position. The camera trocar was placed 2cm above the umbilicus, with two additional 8-mm ports inserted at the mid-clavicular line bilaterally and a 12-mm port on the left-hand side. The appendix was visualized and measured. The appendix was prepared and pediculized. Posterior bladder wall detrusorotomy was performed. The appendix was spatulated, an anastomosis was created between the appendix and the bladder, and the detrusor was closed on the appendix. The total surgical time was 210 min and the hospital stay was limited to 4 days. Aside from hematuria (Clavien-Dindo II) and initial urge incontinence at the appendicovesicostomy level, no postoperative complications were observed within 20 months of follow-up.
CONCLUSIONS
Robot-assisted Mitrofanoff appendicovesicostomy in children is feasible. Further comparison with the classical open procedures is necessary.
18:03 - 18:08
S13-6 (VP)
Neehar PATIL, Parviz HAJIYEV, Kristina GAM, Sean HOU and Mohan GUNDETI
University of chicago, PEDIATRIC UROLOGY, Bengaluru, INDIA
PURPOSE
To allow children with bladder dysfunctions to achieve social continence, continent catheterizable channels are effective alternatives to inter- mittent self-catheterization . We have aimed to describe our modifications to the contemporary Robotic assisted laparoscopic mitrofanoff appendicovesicostomy (RALMA) and to report the long term outcomes.
MATERIAL AND METHODS
This is a retrospective study of a prospectively maintained database from 2008 - 2023. All children with neurogenic bladder s who have undergone RALMA were included. We have described our 10 step modification to improve the overall outcomes. All children were followed up annually. Failure in our study was described as stomal incontinence at follow up (presence of urine leakage ) requiring a surgical revisions.
RESULTS
A total of 69 children were included in our study of which , 34 children underwent our 10 step modification in RALMA . Our technique showed a significant decrease in the length of hospital stay (6.8 days +/-3.6) and operative time(444 min +/-179) . Incontinence at follow up was noted in 6 children ,of which 4 required surgical revisions .Continence rates were 91.2%
CONCLUSIONS
The 10 step modification described by us in RALMA, helps in the optimization of surgical steps further reducing the operative time , making this already safe and effective approach a more sustainable operative modality with good long term outcomes.