Parallel Meeting on Friday 5, September 2025, 10:00 - 10:40
10:00 - 10:03
S32-1 (OP)
Sydney DELOR 1, Nicole RONCZKOWSKI 1, Bradley MORGANSTERN 2 and Bruce RAMSHAW 3
1) Medical College of Georgia at Augusta University, Augusta, USA - 2) Children's Hospital of Georgia, Pediatric Urology, Augusta, USA - 3) Caresyntax, Larkspur, USA
PURPOSE
The AirSeal® Continuous Pressure Insufflator is designed to maintain stable intraperitoneal pressure and enhance visualization during laparoscopic surgery, potentially minimizing operative complications. We previously demonstrated AirSeal's safety in pediatric urologic surgery for patients under 20 kg. It is thought that lower insufflation pressures may reduce perioperative pain, leading us to hypothesize that they would result in less variability in perioperative vital signs. Here, we investigate AirSeal outcomes at lower insufflation pressures, comparing 12 mmHg and 8 mmHg.
MATERIAL AND METHODS
This mixed retrospective and prospective study analyzed robot-assisted laparoscopic pyeloplasty cases performed at 12 mmHg (2018 to 2021, n equals 24) and 8 mmHg (2021 to 2024, n equals 29). Pre-, intra-, and post-operative variables, including vitals, pain management, length of stay, and complications, were assessed using Student's t-tests or Mann-Whitney U analyses as appropriate.
RESULTS
The 8 mmHg group had a shorter length of stay and lower complication rates and severity, though these differences were not statistically significant (p equals 0.45). Significant intraoperative differences were observed in diastolic blood pressure, peak airway pressure minimum and variability, and heart rate maximum and variability (p less than 0.05). Importantly, no complications were reported due to AirSeal use in either group.
CONCLUSIONS
Our findings suggest AirSeal may be beneficial in cases favoring lower insufflation pressures, especially in smaller patients. While intraoperative differences were observed, their clinical significance remains unclear. Our work is ongoing to further evaluate AirSeal's safety and efficacy in pediatric urology and assess the impact of intraoperative parameter adjustments.
10:03 - 10:06
S32-2 (OP)
Lauren PONIATOWSKI, Courtney WEYAND and Nicolas FERNANDEZ
Seattle Children's Hospital, Pediatric Urology, Seattle, USA
PURPOSE
Pediatric robotic-assisted pyeloplasty is a frequently performed procedure that requires teamwork across operating room roles. The intraoperative bedside ureteral stent insertion step was identified as requiring high-level coordination of skillsets between the console surgeon, bedside assistant, surgical technologist and circulating nurse. The objectives were to design a workflow for developing a surgical simulation intervention based on a clinical goal and evaluate the effect of utilization of surgical simulation on time for ureteral stent insertion in the clinical setting.
MATERIAL AND METHODS
The simulation session utilized team-based simulation training elements of facilitator-guided, post-event structure with addition of within-team brainstorming and problem solving. During the simulation intervention, the procedural approach was refined at each iteration. Time for completion of the ureteral stent insertion step in the clinical setting was evaluated pre and post-simulation intervention.
RESULTS
Procedural changes created as a result of the surgical simulation included an objective guide for amount of wire inserted, clarification of the roles of the bedside assistant and surgical technologist, guidance on concomitant completion of procedural steps in each role, reference chart for stent length for circulating nurse and surgical warm-up video for team review preop. The average time for stent insertion decreased from 14 minutes pre-simulation to 8 minutes post-simulation (not statistically significant).
CONCLUSIONS
Surgical simulation utilizing a simulation workflow and novel debrief structure incorporating team-based problem solving allows for procedural improvements. When applied to the ureteral stent insertion step of pediatric robotic-assisted pyeloplasty, there were trends toward increased OR efficiency.
10:06 - 10:09
S32-3 (OP)
David FAWKNER-CORBETT 1, Stephen GRIFFIN 1, David KEENE 2, Pankaj MISHRA 3, Tamas CSERNI 2, Massimo GARRIBOLI 3, Sharon MOHAN KUNNATH 3, Ionica STOICA 3 and Ewan BROWNLEE 1
1) Southampton Children's Hospital, Department of Paediatric Urology, Southampton, UNITED KINGDOM - 2) Royal Manchester Children's Hospital, Department of Paediatric Urology, Manchester, UNITED KINGDOM - 3) Evelina London Children's Hospital, Department of Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Versius surgical robotic system(CMR Surgical) requires smaller incisions with a modular, fully wristed design. Evidence of its efficacy in children is required.
We report initial safety and efficacy of this system in a range of paediatric urological procedures alongside quantification of a learning curve.
MATERIAL AND METHODS
As part of an ongoing prospective, multi-centre, multi-surgeon safety and efficacy study of the Versius system (CA-00533/NCT06539442), this is an interim analysis of cases performed, case mix, demographics, and complications. Post operative outcomes were recorded alongside operative times to quantify the learning curve for this system.
RESULTS
To date,52 procedures have been successfully performed using the Versius system (7months, 3 centres, 6 paediatric urologists). Cases included pyeloplasty (n=34, 2 redo), ureteric reimplantation(n=7), excision of urachus(n=4), nephrectomy/nephrouretectomy(n=3), mitrofanoff (n=2) and ileal conduit(n=2). Median age was 10 years (range 3mn-17.2yr). There have been no safety issues with the device. There have been two conversions due to patient anatomy (one to laparoscopic, one to open).
With regards to pyeloplasty, median length of stay was 2 days (range 1-8, LOS 1day n=17). Across all centres median total operative time was 194 minutes (range 115-379). Operative time for pyeloplasty showed a reduced trend that approached significance comparing early months with later months (197(Standard deviation[SD] 68)minutes month 1-2, vs 178(SD 57)minutes months 4-7, p=0.068).
CONCLUSIONS
First experience with the Versius robot in paediatric urology has demonstrated it to be safe and effective across multiple centres. The average learning curve appears to be 8 cases when adapting to this approach.
10:20 - 10:23
S32-4 (OP)
Ji Yong HA 1, Hye Jin BYUN 1, Teak Jun SHIN 1, Hyeon Chan JANG 1, Wonho JUNG 1, Jong Hoon LEE 2 and Byung Hoon KIM 1
1) Keimyung university school of medicine, Dongsan Hospital, Urology, Daegu, REPUBLIC OF KOREA - 2) Samsung Medical Center, Sungkyunkwan University School of Medicine,, Department of Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
This study presents a modified technique for laparoscopic transcutaneous extraperitoneal (LTE) repair of pediatric hydrocele, alongside an analysis of clinical outcomes over ten years of experience.
MATERIAL AND METHODS
A prospective, single-arm cohort study was initiated in June 2014. Pediatric patients with hydrocele underwent LTE repair utilizing a J-shaped bent needle at our institution from June 2014 to May 2024. The procedure involved the insertion of a 30° laparoscope through a 3-mm umbilical incision to explore the patency of the processus vaginalis. The patent processus vaginalis was then closed extraperitoneally using two J-shaped bent needles (18 and 20 gauge spinal needles) with a 3-0 polyester suture.
RESULTS
Over the ten-year study period, 428 patients with 509 hydroceles underwent LTE repair. Of these, 386 patients with 459 hydroceles, all with at least one year of follow-up, were included in the analysis. The mean age of the patients was 30.4 months (range: 19-105 months), and the mean follow-up duration was 29 months (12-52 months). The overall success rate was 99.1% (455/459 hydroceles). Most patients exhibited an open internal inguinal ring, categorized as slit-like, small, or widely open. Six patients had a closed internal inguinal ring.
Most of patients underwent high ligation alone, while a subset had scrotal aspiration; the success rates between these groups were same. The four cases of recurrence occurred early in the study and were associated with procedures performed without an inguinal incision. Subsequent modifications, including a small 2-mm incision and deep placement of the tie knot, eliminated recurrence.
CONCLUSIONS
The LTE repair technique is safe and effective for the management of pediatric hydrocele. The use of laparoscopy is critical for the accurate diagnosis and treatment of pediatric hydrocele, ensuring high success rates and low recurrence.
10:23 - 10:26
S32-5 (OP)
Veerain GUPTA 1, Brendan FRAINEY 2, Megan STOUT 2, Lauren CORONA 2, Douglass CLAYTON 2, John THOMAS 2 and Cyrus ADAMS 2
1) Vanderbilt University, Department of Urology, Nashville, USA - 2) Vanderbilt University, Department of Pediatric Urology, Nashville, USA
PURPOSE
Same-day discharge (SDD) following robotic-assisted urologic procedures is increasing. However, no studies have compared outcomes for SDD and inpatient (IP) robotic-assisted operations in pediatric patients. This study aims to compare clinical outcomes between SDD and IP for robotic-assisted laparoscopic pyeloplasty (RALP) and ureteroureterostomy (RUU) in children.
MATERIAL AND METHODS
We reviewed patients who underwent RALP and RUU at our pediatric hospital from 2018 to 2024. We compared 30-day Clavien-Dindo complications, hospital readmissions, unplanned phone calls and ED/clinic visits, length of stay (LOS), opioid utilization and re-interventions in SDD and IP.
RESULTS
A total of 164 patients were included (30 SDD, 134 IP) with 146 (89%) RALP and 18 (11%) RUU. Median LOS was 461 minutes for SDD and 1787 minutes for IP (p <0.001). Median follow up was 142 days for SDD and 402 days for IP (p <0.001). Preoperative patient characteristics were not statistically different. There were no significant differences in post-operative phone calls, unplanned visits, complications, readmissions, or re-interventions (Table 1). In both groups, all complications with Clavien-Dindo grade 1-2. Inpatient opioid use was lower in SDD (40% vs 62%, p=0.028), however discharge opioid prescription rates were similar (67% SDD vs 60% IP, p=0.567).
|
|
IP (n=134) |
SDD (n=30) |
p-value |
|
Length of stay, minutes (median (IQR)) |
1787(1599, 1956) |
461(393, 499) |
<0.001 |
|
30-day complications (n,%) |
23 (17.2%) |
5 (16.7%) |
0.948 |
|
30-day readmissions (n,%) |
10 (7.5%) |
2 (6.7%) |
0.880 |
|
Post-operative phone calls (n,%) |
68 (50.7%) |
15 (50%) |
0.941 |
|
Unplanned ED/Clinic visits (n,%) |
26 (19.4%) |
5 (16.7%) |
0.729 |
|
Inpatient opioid use (n,%) |
83 (61.9%) |
12 (40%) |
0.028 |
|
Re-interventions (n,%) |
3 (2.2%) |
1 (3.3%) |
0.725 |
CONCLUSIONS
SDD following RALP and RUU demonstrates comparable outcomes to IP management with reduced inpatient opioid use. SDD should be considered for pediatric patients undergoing RALP or RUU. Long-term outcome follow-up is necessary.
10:26 - 10:29
S32-6 (OP)
Jamie MICHAEL 1, Edward GONG 2, Ashley TALTON 2, Rachel SHANNON 2, Ilina ROSOKLIJA 2, Emilie JOHNSON 2 and Bruce LINDGREN 2
1) Northwestern Medicine, Urology, Chicago, USA - 2) Ann & Robert H Lurie Children's Hospital of Chicago, Pediatric Urology, Chicago, USA
PURPOSE
Evidence increasingly supports robot-assisted laparoscopic (RAL) techniques in complex urologic reconstruction. Our study compares outcomes of children who underwent RAL tapered ureteral reimplantation with those who had open repair at a freestanding pediatric hospital.
MATERIAL AND METHODS
We conducted a retrospective cohort study of children who underwent RAL or open tapered ureteral reimplantation between 2011-2023. We assessed complications, radiographic improvement (decrease in hydronephrosis or resolution of reflux), and reoperation rates. Statistical analysis included chi-square/Fisher’s exact for categorical variables and Mann-Whitney U for continuous variables.
RESULTS
Of 79 patients identified, 44 underwent RAL and 35 underwent open tapered reimplantation. The RAL group was older (1.95 vs. 1.26 years, p=0.008) and more male-dominant (80% vs. 66%, p=0.20). Indications for surgery were similar: 64% of the RAL cohort and 51% of the open cohort underwent surgery for obstruction, and 34% of the RAL group and 49% of the open group for vesicoureteral reflux. RAL procedures had longer operative times (median 285 vs. 218 minutes, p<0.001), but lower blood loss (p=0.007) and opioid use (p=0.014). No significant differences were found in complications or reoperation rates. Radiographic improvement in obstruction was significantly higher in the RAL group (100% vs. 81.3%, p=0.049), though no significant difference was observed in reflux.
CONCLUSIONS
RAL tapered ureteral reimplantation is a safe and effective alternative to open surgery in children. While RAL procedures had longer operative times, they were associated with reduced blood loss and opioid use. RAL also showed better radiographic improvement for obstruction, making it a viable approach for pediatric urologic reconstruction.