BACKGROUND: Robotic-assisted laparoscopic pyeloplasty (RALP) has become a prevalent method to repair ureteropelvic junction obstruction (UPJO) in children of almost all ages. Yet, there is still resistance to using this technique in patients younger than 6 months of age. This may be due to concerns regarding intra-abdominal space, the perceived lack of significant recovery benefit compared to open, and the need for an additional procedure to remove a stent. For the last 4 years, we have refined our RALP approach in young patients, minimizing postoperative stay and leaving stents on a string to avoid a second procedure. We hypothesize that this approach makes it possible to discharge following a RALP on the same day of the procedure.
METHODS: We queried our robotic-assisted surgery database for patients 6 months of age and younger who underwent RALP from January 2020 to present. We retrospectively reviewed information on the patient's age and weight at surgery, surgery length, narcotic use, hospital stay, and early and late complications. We also evaluated success based on a more than 50% reduction of the AP diameter on postoperative renal ultrasound. RALP was performed in a standard fashion and the stent was usually left with a string for later removal in the clinic per the surgeon's preference.
RESULTS: A total of 17 patients who underwent RALP during the study period were identified, including one patient who underwent simultaneous bilateral RALP. The cohort mean age was 4.6 months (1.6-6.9), with a mean weight of 7.15kg (5.3-10.2). The mean operative time was 200 minutes (119-288). Ten patients received no narcotics postoperatively, while 7 received a single dose in the early postoperative period. The average hospital stay was 20 hours; 4 (24%) patients were discharged the same day and 12 patients (70%) were sent home within less than 24 hours. Three patients (18%) experienced an early complication; 2 had pyelonephritis and 1 had urinary retention requiring 24 hours with a urethral catheter, which delayed his discharge. At a mean follow up of 15 months, 1 patient had to have a balloon dilation of the UPJ, while the remaining patients (95%) had a successful outcome.
CONCLUSIONS: RALP is safe, feasible, and has a comparable success rate in patients younger than 6 months of age. Leaving stents with a string in place allows patients to avoid a second procedure. Our cohort showed that RALP may have a possible benefit in shortening the hospital stay and the operation can be safely done as an outpatient procedure in this patient population. Based on our findings, we are implementing steps to change our RALPs into an outpatient procedure entirely.
