Advertisement

Laparoscopic and robotic-assisted repair of retrocaval ureter in children: a multi-institutional comparative study with open repair

  • Maria Escolino
  • Lorenzo Masieri
  • Jean-Stephane Valla
  • Pedro Josè Lopez
  • Baran Tokar
  • Imran Mushtaq
  • Ciro Esposito
Original Article
  • 5 Downloads

Abstract

Purpose

This retrospective study aimed to report a multi-institutional experience with laparoscopic and robotic-assisted repair of retrocaval ureter in children and to compare outcome of minimally invasive surgery (MIS) with open repair.

Methods

The records of all children, who underwent MIS and open repair of retrocaval ureters in six international pediatric urology units over a 5-year period, were retrospectively collected. Data were grouped according to the operative approach: a laparoscopic group (G1) included five patients, a robotic-assisted group (G2) included four patients, and an open group (G3) included three patients. The groups were compared in regard to operative and postoperative outcomes.

Results

At follow-up, all patients (one G1 patient after redo-surgery) reported complete resolution of symptoms and radiologic improvement of hydronephrosis and obstruction. In regard to postoperative complications, one G1 patient developed stenosis of anastomosis and needed re-operation with no further recurrence (IIIb Clavien). G2 reported the lowest average operative time (135 min) compared to G1 (178.3 min) and G3 (210 min). MIS (G1–G2) reported a significantly better postoperative outcome compared to open repair (G3) in terms of analgesic requirements, hospitalization, and cosmetic results.

Conclusions

The study outcomes suggest that MIS should be the first choice for retrocaval ureter because of the minimal invasiveness and the better cosmetic outcome compared to open surgery. Furthermore, our results showed that robotic-assisted reconstruction was technically easier, safer, and quicker compared to laparoscopic repair, and for these reasons, it should be preferentially adopted, when available.

Keywords

Retrocaval ureter Robotics Laparoscopy Children Complications 

Notes

Author contributions

ME: project development, data collection, manuscript writing, and manuscript editing. LM: data collection, data analysis, and manuscript editing. JSV: data collection, data analysis, and manuscript editing. PJL: data collection, data analysis, and manuscript editing. BT: data collection, data analysis, and manuscript editing. IM: data collection, data analysis, and manuscript editing. CE: project development, data analysis, manuscript writing, and manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Lin HY, Chou YH, Huang SP, Li YC, Tsai HN, Jeng HS, Huang CH (2003) Retrocaval ureter: report of two cases and literature review. Kaohsiung J Med Sci 19:127–131CrossRefGoogle Scholar
  2. 2.
    Acharya SK, Jindal B, Yadav DK, Singha S, Bagga D (2009) Retrocaval ureter: a rare cause of hydronephrosis in children. J Pediatr Surg 44:846–848CrossRefGoogle Scholar
  3. 3.
    Bateson EM, Atkinson D (1969) Circumcaval ureter: a new classification. Clin Radiol 20:173–177CrossRefGoogle Scholar
  4. 4.
    Sun JS, Zhang G, Lin T (2015) Retrocaval ureter in children: a report of eight cases. West Indian Med J 64(4):397–399PubMedGoogle Scholar
  5. 5.
    Zhang XD, Hou SK, Zhu JH, Wang XF, Meng GD, Qu XK (1990) Diagnosis and treatment of retrocaval ureter. Eur Urol 18:207–210CrossRefGoogle Scholar
  6. 6.
    Anderson JC, Hynes W (1949) Retrocaval ureter: a case diagnosed preoperatively and treated successfully by a plastic operation. BJU 21:209CrossRefGoogle Scholar
  7. 7.
    Miyazato M, Kimura T, Ohyama C, Hatano T, Miyazato T, Ogawa Y (2002) Retroperitoneoscopic uretero-ureterostomy for retrocaval ureter. Hinyokika Kiyo 48:25–28PubMedGoogle Scholar
  8. 8.
    Ramalingam M, Selvarajan K (2003) Laparoscopic transperitoneal repair of retrocaval ureter: report of two cases. J Endourol 17:85–87CrossRefGoogle Scholar
  9. 9.
    Gundeti MS, Duffy PG, Mushtaq I (2006) Robotic-assisted laparoscopic correction of pediatric retrocaval ureter. J Laparoendosc Adv Surg Tech 16(4):422–424CrossRefGoogle Scholar
  10. 10.
    Smith KM, Shrivastava D, Ravish IR, Nerli RB, Shukla AR (2009) Robot-assisted laparoscopic ureteroureterostomy for proximal ureteral obstructions in children. J Pediatr Urol 5:475–479CrossRefGoogle Scholar
  11. 11.
    Soundappan SV, Barker AP (2004) Retrocaval ureter in children: a report of two cases. Pediatr Surg Int 20:158–160CrossRefGoogle Scholar
  12. 12.
    Matsuda T, Yasumoto R, Tsujino T (1996) Laparoscopic treatment of a retrocaval ureter. Eur Urol 29:115–118CrossRefGoogle Scholar
  13. 13.
    Ameda K, Kakizaki H, Harabayashi T, Watarai Y, Nonomura K, Koyanagi T (2001) Laparoscopic ureteroureterostomy for retrocaval ureter. Int J Urol 8:71–74CrossRefGoogle Scholar
  14. 14.
    Chung BI, Gill IS (2008) Laparoscopic dismembered pyeloplasty of a retrocaval ureter: case report and review of the literature. Eur Urol 54:1433–1436CrossRefGoogle Scholar
  15. 15.
    Salomon L, Hoznek A, Balian C, Gasman D, Chopin DK, Abbou CC (1999) Retroperitoneal laparoscopy of a retrocaval ureter. BJU Int 84:181–182CrossRefGoogle Scholar
  16. 16.
    Gupta NP, Hemal AK, Singh I, Khaitan A (2001) Retroperitoneoscopic ureterolysis and reconstruction of retrocaval ureter. J Endourol 15:291–293CrossRefGoogle Scholar
  17. 17.
    Li HZ, Ma X, Qi L, Shi TP, Wang BJ, Zhang X (2010) Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter: report of 10 cases and literature review. Urology 76(4):873–876CrossRefGoogle Scholar
  18. 18.
    Esposito C, Escolino M, Miyano G, Caione P, Chiarenza F, Riccipetitoni G, Yamataka A, Savanelli A, Settimi A, Varlet F, Patkowski D, Cerulo M, Castagnetti M, Till H, Marotta R, La Manna A, Valla JS (2016) A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey. World J Urol 34(7):939–948CrossRefGoogle Scholar
  19. 19.
    Esposito C, Escolino M, Lopez M, Farina A, Cerulo M, Savanelli A, La Manna A, Caprio MG, Settimi A, Varlet F (2016) Surgical management of pediatric vesicoureteral reflux: a comparative study between endoscopic, laparoscopic, and open surgery. J Laparoendosc Adv Surg Tech A 26(7):574–580CrossRefGoogle Scholar
  20. 20.
    Esposito C, Masieri L, Steyaert H, Escolino M, Cerchione R, La Manna A, Cini C, Lendvay TS (2018) Robot-assisted extravesical ureteral reimplantation (revur) for unilateral vesico-ureteral reflux in children: results of a multicentric international survey. World J Urol 36(3):481–488CrossRefGoogle Scholar
  21. 21.
    Alkhudair WK, Seyam R, Al Zahrani HM, Al Otaibi MF, Al Taweel W (2012) Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment. CUAJ 6(2):E38–E41CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maria Escolino
    • 1
  • Lorenzo Masieri
    • 2
  • Jean-Stephane Valla
    • 3
  • Pedro Josè Lopez
    • 4
  • Baran Tokar
    • 5
  • Imran Mushtaq
    • 6
  • Ciro Esposito
    • 1
  1. 1.Division of Pediatric Surgery“Federico II” University of NaplesNaplesItaly
  2. 2.Division of Pediatric UrologyMeyer Children HospitalFlorenceItaly
  3. 3.Division of Pediatric UrologyCHU LenvalNiceFrance
  4. 4.Division of Pediatric UrologyHospital Exequiel Gonzalez Cortes and Clinica AlemanaSantiagoChile
  5. 5.Division of Pediatric UrologyEskisehir Osmangazi UniversityEskisehirTurkey
  6. 6.Division of Pediatric UrologyGreat Ormond Street HospitalLondonUK

Personalised recommendations