Background: Minimally invasive surgery (MIS) has dramatically increased in popularity in the adult population, but the same momentum has yet to be seen in pediatrics. We aim to assess current trends over the past 22 years in the usage and demographics of laparoscopic and robotic surgery in pediatric urology.
Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) to collect inpatient data between 1997-2019. ICD-9 and -10 codes were queried to identify patients that received open and minimally invasive pediatric urology procedures as well as their demographic data. Descriptive statistics and multivariate analysis were performed using statistical analysis software (SAS).
Results: We identified seven procedures that are performed either laparoscopically or robotically in pediatric patients: ureteroneocystostomy, pyeloplasty, complete nephrectomy, partial nephrectomy, appendicovesicostomy, bladder augmentation, bladder outlet repair (sling). 81,497 procedures (weighted value) were analyzed, 75,547 (93%) were performed open while 5,950 (7%) were performed with MIS. In 1997, <1% of these procedures were performed minimally invasively; by 2019 this percentage increased to 24%. Pyeloplasty saw the largest mean yearly increase in usage of robotic and laparoscopic techniques (2.3%). Following was nephrectomy (1.8%) and partial nephrectomy (1.4%) (Figure 1). By 2019, 41.2% of pyeloplasties were performed minimally invasively (Figure 2). Odds ratio for complications after receiving MIS was 0.56 when compared to open surgery (p<0.001). Demographic data was similar in both groups. Minimally invasive procedures were more often performed on older children and at larger medical centers (Table 1).
Conclusions: Laparoscopic and robotic surgical options are becoming increasingly utilized in the pediatric population. The most common procedures now performed minimally invasively in pediatrics are pyeloplasty and nephrectomy. Demographic data, excluding age, does not appear to have a strong effect on whether a patient received a minimally invasive or open procedure.
