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. 2023 Mar 31:51:55-61.
doi: 10.1016/j.euros.2023.03.004. eCollection 2023 May.

Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible?

Aline Broch  1 , Annabel Paye-Jaouen  2 , Beatrice Bruneau  3 , Mathilde Glenisson  1   4 , Kiarash Taghavi  1   5   6 , Nathalie Botto  1 , Jeanne Goulin  1 , Pauline Lopez  2   4 , Stefania Querciagrossa  7 , Alaa El Ghoneimi  2   4 , Souhayl Dahmani  3   4 , Mary Hidalgo  7 , Thomas Blanc  1   4
Affiliations

Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible?

Aline Broch et al. Eur Urol Open Sci. .

Abstract

Background: Robot-assisted pyeloplasty is the most frequently performed robotic procedure in children. A retroperitoneal approach limits surgical trauma and avoids peritoneal irritation. This led to the establishment of the criteria for day surgery (DS) and a related clinical care pathway.

Objective: To assess the feasibility and safety of DS in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty (R-RALP).

Design setting and participants: We performed a bicentric prospective study (NCT03274050) over 2 yr involving the two major paediatric urology teaching hospitals in Paris. A clinical pathway and a prospective research protocol were specifically established.

Intervention: DS in selected children undergoing R-RALP.

Outcome measurements and statistical analysis: The primary outcomes were DS failure, 30-d complications, and readmission rates. The secondary outcomes included preoperative characteristics, perioperative parameters, and surgical outcomes. Quantitative variables were expressed as medians with interquartile ranges.

Results and limitations: Thirty-two children fulfilled specific inclusion criteria and were consecutively selected for DS following R-RALP. The median patient age was 7.6 yr (4.1-11.8) and weight 25 kg (14-45). The median console time was 137 min (108-167). There were no intraoperative complications or conversions. Six children were kept under observation overnight and discharged the following day due to persistent pain (n = 3), parental anxiety (n = 2), or a prolonged procedure (n = 1). The median duration of hospital stay of the 26 children in the DS setting was 12.7 h (12.2-13.2). During the 30-d period, there were four emergency room visits (15%) resulting in two patients requiring readmission (8%): one for febrile urinary tract infection (Clavien-Dindo II) and one child with no JJ stent for urinoma (Clavien-Dindo IIIb). Radiological studies confirmed improvement in dilatation for all cases with no recurrence (median follow-up: 15 mo).

Conclusions: This prospective case series is the first to demonstrate the feasibility and safety of DS in children undergoing R-RALP, obviating the need for routine inpatient care. Excellent results can be achieved by careful patient selection, a clear clinical pathway, and a dedicated team. Further evaluation is warranted to assess the cost effectiveness.

Patient summary: This study shows that day surgery after robotic pyeloplasty is both safe and effective in selected children.

Keywords: Ambulatory; Day surgery; Outpatient; Paediatrics; Pyeloplasty; Retroperitoneal; Robot-assisted laparoscopy; Ureteropelvic junction obstruction.

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Figures

Fig. 1
Fig. 1
Flowchart of the study population. RALP = robot-assisted laparoscopic pyeloplasty.
See this image and copyright information in PMC

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