The missed crossing vessel during open pyeloplasty: a potential advantage of the robot-assisted approach in children

J Robot Surg. 2024 Jul 16;18(1):285. doi: 10.1007/s11701-024-02006-5.

Abstract

Objective: To investigate whether the panoramic view offered by robot-assisted laparoscopic pyeloplasty (RALP) reduces the likelihood of missing a crossing vessel compared to open pyeloplasty in cases where initial pyeloplasty fails.

Methods: A single institution redo-pyeloplasty database was reviewed for children treated between January 2012 to July 2023. Clinical history, imaging and operative details were reviewed to identify the etiology for the redo procedure.

Results: Cohort consisted of 45 patients undergoing a redo RALP during the study period. 29 of 45 patients had an initial open surgical approach, whereas 16 had an initial RALP. 10 patients were noted to have a missed crossing vessel on redo pyeloplasty - 9 had an initial open approach whereas 1 had an initial RALP (p<0.0001).

Conclusions: RALP may reduce the risk of missing a crossing vessel due to the panoramic view of the surgical field intrinsic to an intraperitoneal RALP approach.

Keywords: Crossing vessel; Minimally invasive surgery; Pediatrics; Pyeloplasty; Ureteropelvic junction obstruction.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Kidney Pelvis* / surgery
  • Laparoscopy* / methods
  • Male
  • Reoperation / methods
  • Retrospective Studies
  • Robotic Surgical Procedures* / methods
  • Ureteral Obstruction* / surgery
  • Urologic Surgical Procedures / methods