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Robotic upper tract surgery in infants 6 months or less: is there enough space?

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Abstract

Robot-assisted laparoscopic surgery (RALS) has recently been described in children < 1 year old. However, little data exist on robotic utilization in infants ≤ 6 months old, likely due to concerns for limited intraabdominal space and decreased distance between ports in this cohort. We hypothesized that the robotic approach can be successfully used for infants ≤ 6 months old. A prospectively collected database of patients undergoing urologic robotic surgery at our institution was reviewed. Patients ≤ 6 months and ≥ 4 kg were included. Patient demographics, intraoperative details, hospital length of stay, and complications were reviewed. Descriptive statistics were performed. Twelve patients ≤ 6 months old underwent urologic robotic surgery by three surgeons at our institution (2013–2019): pyeloplasty (6), ureteroureterostomy (4), heminephrectomy (1), and nephrectomy (1). Median age at surgery was 4.75 months (IQR 4, 6). Median weight was 7.09 kg (IQR 6.33, 7.78). Median console time was 105 min (IQR 86, 123). For all procedures, 8-mm robotic arm ports were used. No procedures were converted to open. Median post-operative hospital stay was 24 h (IQR). Febrile UTI was the only complication occurring within 30 days of surgery (n = 4, 33%; 7–20 days, Clavien grade 2). For those undergoing pyeloplasty or ureteroureterostomy (n = 10), postoperative ultrasound showed improved (n = 9) or stable hydronephrosis (n = 1). At a median follow-up of 19.73 months (IQR 4.27, 38.32), no patient required an unplanned secondary intervention. Robotic upper urinary tract surgery is feasible and safe in patients ≤ 6 months of age and can be performed successfully with the same technique as for older children.

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, 611 E Livingston Avenue, Columbus, OH, 43205, USA

    Alex J. Carsel & Daryl J. McLeod

  2. Department of Urology, Nationwide Children’s Hospital, Columbus, OH, USA

    Daniel G. DaJusta, Christina B. Ching, Daryl J. McLeod, Molly E. Fuchs & Alexandra W. Rehfuss

  3. Operating Room-Robotics Coordinator, Nationwide Children’s Hospital, Columbus, OH, USA

    Jennifer Smith

Authors
  1. Alex J. Carsel
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  2. Daniel G. DaJusta
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  3. Christina B. Ching
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  4. Daryl J. McLeod
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  5. Jennifer Smith
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  6. Molly E. Fuchs
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  7. Alexandra W. Rehfuss
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Correspondence to Alex J. Carsel.

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This study was approved by the IRB at Nationwide Children’s Hospital (IRB 16–00249).

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Carsel, A.J., DaJusta, D.G., Ching, C.B. et al. Robotic upper tract surgery in infants 6 months or less: is there enough space?. J Robotic Surg 16, 193–197 (2022). https://doi.org/10.1007/s11701-021-01231-6

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  • DOI: https://doi.org/10.1007/s11701-021-01231-6

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