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Contemporary National Comparison of Open, Laparoscopic and Robotic-Assisted Laparoscopic Pediatric Pyeloplasty
Chad Ellimoottil, MD1, John Cashy, PhD2, Andrew Flum, MD1, Jessica Casey, MD1, Mark Faase, MD1, Edward Gong, MD1, Dennis B. Liu, MD1.
1Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

BACKGROUND: : Minimally invasive pyeloplasty (MIP) is increasingly utilized for the surgical management of pediatric ureteropelvic junction obstruction (UPJO). Previous studies have focused on free-standing children’s hospitals and did not distinguish laparoscopic pyeloplasty (LP) from robot-assisted laparoscopic pyeloplasty (RALP).
METHODS: Using the 2009 Kids' Inpatient Database (KID), we assessed patient and hospital characteristics of pediatric patients with UPJO who underwent open pyeloplasty (OP), LP and RALP. We also evaluated the utilization of MIP over time.
RESULTS:
In 2009, there were 3,354 pediatric pyeloplasties performed in the U.S. (85% OP, 3% LP, 12% RP). Compared to 2000, this represents a 17.4% decrease in the overall number of pyeloplasties but a 3.6 fold increase in the utilization of MIP (Figure 1). Mean patient age was 3.7 yrs for OP, 9.3 yrs for LP and 9.9 yrs for RALP. Both OP and MIP were more commonly performed in females, Caucasians, patients with private insurance, at urban hospitals and at teaching hospitals. While length of stay (LOS) in days was statistically lower for MIP (3.46 OP, 2.86 LP, 1.96 RP, p<0.001), total cost between the groups was not statistically different. On multivariable logistic regression analysis, age (OR 1.17, p<0.001) was associated with increased use of MIP.
CONCLUSIONS: While utilization of MIP is increasing in the U.S., especially in older children, OP remains predominant. While robotic surgery is typically more costly, in the case of RALP, cost savings from decreased LOS appear to make overall costs between RALP and OP similar.


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