Abstract
With increased experience, many laparoscopic procedures have evolved from mandatory same-day admission to the outpatient setting. Given the shorter operative time and length of stay, the potential to perform robotic surgery as an outpatient procedure exists. We sought to describe our initial experience with performing robotic-assisted laparoscopic pyeloplasty (RP) on children in an outpatient setting. We retrospectively reviewed a prospectively collected database of all patients undergoing RP from July 2012 to May 2014 by a single surgeon. All patients discharged home within 12 h of completion of surgery were included in the analysis. Prior to discharge the Wong–Baker Pain Scale 1–10 was reviewed and given to all patients. All patients were prescribed oxybutynin and phenazopyridine for bladder spasms and stent discomfort. Post-operative follow-up telephone calls were made inquiring about oral intake, pain control, constitutional symptoms, and voiding issues. Readmission rates and post-operative outcomes were reviewed. During the study period, 62 children underwent RP and 13 patients (21 %) were selected for outpatient management. These 7 boys and 6 girls had a mean age of 8.1 years old. Of the 13 patients, 11 patients had left-sided procedures and 2 had right; all had primary UPJO. Mean pain score was 2.7 in the first 12 h at home. Within 24 h, the pain score decreased to a mean of 2.2. No patient required opioid analgesics and no child required admission after surgery. At 3-month follow-up, 7 patients had resolved hydronephrosis, 5 had improved hydronephrosis and 1 was unchanged. MAG3 renal scan in the latter patient showed no sign of obstruction. Outpatient RP is feasible and appears to be safe. Great care must be taken when selecting which patients can be fast tracked.
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Abbreviations
- UPJO:
-
Ureteropelvic junction obstruction
- RP:
-
Robotic-assisted laparoscopic pyeloplasty
- LP:
-
Laparoscopic pyeloplasty
References
Frazee RC, Abernathy SW, Davis M, Hendricks JC, Isbell TV, Regner JL et al (2013) Outpatient laparoscopic appendectomy should be the standard of care for uncomplicated appendicitis. Trauma Acute Care Surg 76(1):79–83
Chaussy Y, Becmeur F, Lardy H, Aubert D (2013) Robot-assisted surgery: current status evaluation in abdominal and urological pediatric surgery. J Lapendo Adv Surg Tech 23(6):530–539
Rubinstein M, Finelli A, Moinzadeh A, Singh D, Ukimura O, Desai MM et al (2005) Outpatient laparoscopic pyeloplasty. Urology 66:41–44
Schluessler WW, Grune MT, Tecaunhuey LV, Preminger GM (1993) Laparoscopic dismembered pyeloplasty. J Urol 150:1795–1799
Braga LHP, Pace K, DeMaria J, Lorenzo AJ (2009) Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications and success rate. Eur Urol 56:848–858
Camarillo DB, Krummel TM, Salisbury JK (2004) Robotic technology in surgery: past, present and future. Am J Surg 188:2–15
Sprunger JK, Reese CT, Decter RM (2001) Can standard open pediatric urological procedures be performed on an outpatient basis? J Urol 166:1062–1064
Van Batavia JP, Casale P (2014) Robotic surgery in pediatric urology. Curr Urol Rep 15:402–409
Tomaszewski JJ, Casella DP, Turner RM, Casale P, Ost MC (2012) Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol 26(6):602–613
Casale P (2010) Laparoscopic and robotic approach to genitourinary anomalies in children. Urol Clin N Am 37:279–286
Lee RS, Retik AB, Borer JG, Peters CA (2006) Pediatric robot assisted laparoscopic dismembered pyeloplasty with a cohort of open surgery. J Urol 175:683–687
Yee DS, Shanberg AM, Duel BP, Rodriguez E, Eichel L, Rajpoot D (2006) Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children. Urology 67:599–602
Palmer JS (2008) Extravesical ureteral reimplantation: an outpatient procedure. J Urol 180:1828–1831
Vernon DTA (1965) The psychological responses of children to hospitalization and illness: a review of the literature. Thomas, Springfield
De Jonge WJ, Van Den Wijngaard RM, The FO, Ter Beek MLT, Bennink RJ, Tytgat GNJ et al (2003) Postoperative ileus is maintained by intestinal immune infiltrates that activate inhibitory neural pathways in mice. Gastroenterology 125:1137–1147
Kalff KC, Carlos TM, Schraut WH, Biliar TR, Simmons RL, Bauer AJ (1999) Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 117:378–387
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Julia Finkelstein, Jason Van Batavia and Pasquale Casale all declare that they have no conflict of interest.
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All procedures followed were in accordance with the ethical standards of the responsible committee of human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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Informed consent was obtained from all patients for being included in the study.
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Finkelstein, J.B., Van Batavia, J.P. & Casale, P. Is outpatient robotic pyeloplasty feasible?. J Robotic Surg 10, 233–237 (2016). https://doi.org/10.1007/s11701-016-0577-9
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DOI: https://doi.org/10.1007/s11701-016-0577-9