Robot-assisted laparoscopic surgery for treatment of urinary tract stones in children: report of a multicenter international experience

Abstract

This study aimed to report a multi-institutional experience with robot-assisted laparoscopic surgery (RALS) for treatment of urinary tract stones in children. The medical records of 15 patients (12 boys), who underwent RALS for urolithiasis in 4 international centers of pediatric urology over a 5-year period, were retrospectively collected. The median patient age was 8.5 years (range 4-15). Eleven/fifteen patients (73.3%) had concurrent uretero-pelvic junction obstruction (UPJO) and 2/15 patients (13.3%) had neurogenic bladder. Stones were in the renal pelvis in 8/15 (53.3%), in the lower pole in 3/15 (20%), in the bladder in 2/15 (13.3%), and in multiple locations in 2/15 (13.3%). One patient (6.6%) had bilateral multiple kidney stones. The median stone size was 10.8 mm (range 2-30) in upper tract location and 27 mm (range 21-33) into the bladder. Eleven patients with concomitant UPJO underwent simultaneous robot-assisted pyelolithotomy and pyeloplasty in 12 kidney units. Two patients with isolated staghorn stones received robot-assisted pyelolithotomy. Robot-assisted cystolithotomy was performed in two patients with bladder stones. The median operative time was 131.8 min (range 60-240). The stone-free rate was 80% following initial surgery and 100% after secondary treatment. Clavien 2 complications (hematuria, infections) were recorded in 5/15 patients (33.3%). Three/fifteen patients (20%) with residual renal stones were successfully treated using ureterorenoscopy (Clavien 3b). RALS was a feasible, safe and effective treatment option for pediatric urolithiasis in selected cases such as large bladder stones, bilateral kidney stones, staghorn stones or concomitant anomalies such as UPJO requiring simultaneous pyeloplasty.

Keywords: Children; Lithotomy; Nephroscopy; Pyeloplasty; Robot; Stones.

Fig. 1

Patient (a) and ports (b) position in a simultaneous right pyelolithotomy and pyeloplasty

Fig. 2

Operative steps of pyelolithotomy: the renal pelvis is opened and the stone is extracted using robotic graspers (a); the ureteroscope is introduced into the renal pelvis (b) and the residual fragments are removed under vision (c); a double J stent is inserted (d); the renal pelvis is closed using interrupted stitches (e); the stone is extracted (f)

Fig. 3

Bilateral multiple kidney stones: KUB (a) and intra-operative view (b)

Fig. 4

Large bladder stone: KUB (a); intra-operative view (b); ex vivo (c)