+
MODEL
Journal of Pediatric Urology (2014) xx, 1e5
Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery John L. Schomburg, Ken Haberman, Katie H. Willihnganz-Lawson, Aseem R. Shukla* Section of Pediatric Urology, University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN, USA Received 30 August 2013; accepted 25 February 2014
KEYWORDS Vesicoureteral reflux; Robot-assisted laparoscopy; Ureteral reimplantation
Abstract Objective: The aim was to report a single surgeon’s experience comparing open and robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) to treat vesicoureteral reflux (VUR). Subjects and methods: We retrospectively reviewed the outcomes of RALUR and open extravesical ureteral reimplantations consecutively performed by a single surgeon between January 2008 and December 2010 using the da Vinci Surgical System. Both groups of patients were subjected to identical pre- and postoperative care protocols. Results: During the defined study interval, 20 open and 20 RALUR procedures were completed by a single surgeon at our institution. Gender and VUR grade were similar in both cohorts. Operative times were longer in the RALUR group, but postoperative opioid use (morphine equivalents) was significantly lower in the RALUR group (RALUR: 0.14 mg/kg, open: 0.25 mg/kg, p Z 0.021). There was no significant difference in estimated blood loss (EBL) or length of hospitalization (LOH). The overall rate of surgical complications was similar; however, the complications in the open group tended to be less severe than those occurring in the RALUR group. On follow-up, after a median of 52 months for open surgery and 39 months for RALUR, two children had developed a febrile urinary tract infection in both groups, of which one in the open group had persistent VUR. Conclusion: This single-surgeon experience of open and initial experience with RALUR performed with the same surgical technique on consecutive cohorts with identical post-surgical
* Corresponding author. The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA. Tel.: þ1 215 590 7889; fax: þ1 215 590 3985. E-mail address: [email protected] (A.R. Shukla). http://dx.doi.org/10.1016/j.jpurol.2014.02.013 1477-5131/ª 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
Please cite this article in press as: Schomburg JL, et al., Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery, Journal of Pediatric Urology (2014), http://dx.doi.org/10.1016/j.jpurol.2014.02.013
+
MODEL
2
J.L. Schomburg et al. care protocol allows a comparative analysis of outcomes for a surgeon transitioning to RALUR. The RALUR reduces postoperative analgesic requirements while yielding similar clinical outcomes as the open technique. ª 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
Introduction
Study design and data collection
It is estimated that 1e3% of children, and up to 30% of those with urinary tract infections, suffer from vesicoureteral reflux (VUR) [1]. Left untreated, symptomatic VUR can be a risk for recurrent pyelonephritis and its associated morbidity. While several treatment alternatives exist for VUR, the gold standard surgical alternative for clinically significant VUR remains open surgery with either an intravesical or extravesical ureteral reimplantation. With the goal of reducing the morbidity associated with open surgery, laparoscopic and robot-assisted laparoscopic (RAL) procedures in children have been described as viable minimally invasive alternatives to open surgery for many pediatric urologic conditions. For various procedures, patients undergoing RAL are experiencing shorter hospital stays, decreased pain medication requirements, and improved cosmesis when compared to patients who underwent open surgery [2,3]. The laparoscopic extravesical ureteral reimplantation was first described in 1994 [4], and was later shown to produce similar results as the open technique while reducing postoperative discomfort [5]. However, this technique was not widely adopted as the approach is technically challenging [6]. The same technique was later adapted for use with the surgical robot, overcoming many of those challenges. Initial experience with the robotassisted laparoscopic ureteral reimplantation (RALUR) showed high rates of VUR resolution with few complications, including a low rate of urinary retention [2,7]. However, these early feasibility studies did not include a control group. By comparing a single surgeon’s experience with the open and RAL approaches to the extravesical ureteral reimplantation, we sought to compare treatment outcomes and the feasibility of transitioning to RALUR in a pediatric urology practice.
After obtaining approval from the University of Minnesota Institutional Review Board, patient data were obtained retrospectively from the electronic medical record. Preoperative evaluation included voiding cystourethrogram (VCUG) to assess the grade of VUR as well as renal ultrasound or nuclear medicine scan to evaluate for renal scarring, atrophy and differential function. While nuclear renography was obtained preoperatively in some patients, there was no absolute criteria for consideration for surgery. Parent preference played a key role in decision making prior to surgery. Every child in the open and RALUR groups had experienced at least one febrile urinary tract infection prior to surgery, and all children had VUR present on VCUG. While adjunctive studies such as a DMSA scan were obtained for patients preoperatively, there were no absolute criteria by DMSA prior to consideration for surgery. Parent preference played a key role in decision-making process prior to surgery. All parents were appropriately counseled regarding all management options, including observation with or without prophylactic antibiotics, endoscopic injection of bulking agents, or ureteral reimplantation. Since the adoption of the RALUR at our institution in 2008, the procedure is offered to all patients considered candidates for ureteral reimplantation over 18 months of age. Children under that age are typically offered only the open approach due to surgeon preference. An open approach is also preferred in cases of a ureterocele or likely need for ureteral tapering, but those patients were not included in this analysis. Operative times represent total in-room time for both open and RALUR groups, including port placement, robot docking, and console times for the RALUR group. EBL was as recorded in the operative reports. Pain medication data were collected from inpatient medication administration reports. The majority of patients were given hydrocodone orally as needed and acetaminophen. Rare patients were given intravenous morphine, intravenous dilaudid, or ibuprofen orally. Total narcotic administered was calculated and was converted using a correction factor (0.5 mg of intravenous hydrocodone or 6.66 mg of intravenous dilaudid) to IV morphine equivalents, which was then standardized for patient weight. Non-narcotic pain medication was also included in the analysis. As all pain medications were prescribed as needed, the total number of pain medication dosages of any type was also totaled for each patient. No patients received an epidural or patient controlled analgesia. Follow-up data were obtained from the electronic medical record. While the only way to definitively confirm resolution of reflux is with postoperative VCUG, the retrospective nature of this study precludes this as it is not our
Materials and methods Patient selection A total of 20 patients underwent RALUR by a single surgeon (AS) at our institution during the defined study period (January 2008 to December 2010). A group of 23 consecutive patients undergoing extravesical ureteral reimplantation by the same surgeon during the same time period was identified; three patients with previous or concomitant intra-abdominal surgery were excluded. All children undergoing unilateral or bilateral intravesical ureteral reimplants during the same time period were also excluded from analysis.
Please cite this article in press as: Schomburg JL, et al., Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery, Journal of Pediatric Urology (2014), http://dx.doi.org/10.1016/j.jpurol.2014.02.013
+
MODEL
Robot-assisted laparoscopic ureteral reimplantation standard practice to obtain VCUG in each patient following surgery. Since the success of the open and RALUR techniques we utilized were previously confirmed both internally and in previous reports [7] with routine postoperative VCUGs, a VCUG was offered to all families, but obtained postoperatively only upon family preference or in instances where patients developed a febrile urinary tract infection following surgery. Operative success was therefore defined as absence of febrile urinary tract infections; where VCUG was obtained, success was defined by radiographic evidence of VUR resolution. Complications were identified from the medical record and graded with the ClavieneDindo classification system [8]. Statistical analysis was performed using Microsoft Excel. Data were analyzed using paired, two-tailed t tests. Statistical significance was defined as p < 0.05.
Surgical technique Our RALUR technique is similar to what has previously been described in the literature [7], using the same fundamental principles utilized for an open extravesical reimplantation, with the exception that a transperitoneal approach is used to access the ureter and bladder. Cystoscopy is performed only when ectopic ureteral insertion is suspected. For the robotic camera port, an 8 or 10 mm port is inserted just inferior to the umbilicus. Two 5 mm robotic ports are placed on the right and left midclavicular line approximately 1 cm inferior to the umbilicus. No fourth, assistant port, is placed. The da Vinci Surgical System is docked in standard fashion. The ureters are identified distal to the round ligament in females and vas deferens in males, and mobilized to their insertion in the bladder. Care is taken to minimize the use of electrocautery lateral to this insertion point. The detrusor is incised and separated using sharp dissection and intermittent monopolar cautery with the endowrist cautery hook, leaving the mucosa intact. A detrusor incision to ureteral diameter ratio of 4 or 5:1 is maintained. To aid in elongating the detrusor trough during detrusorrhaphy, a 2.0 polypropylene suture on a Keith needle (or straightened SH needle for smaller patients) is passed suprapubically into the peritoneal space and used to hitch the bladder anteriorly. A series of simple interrupted 5-0 polydioxanone stitches are used to close the detrusor over the ureter, after which the retraction suture is relaxed.
3
Results Patient demographics and clinical features are presented in Table 1. Five patients in the RALUR and six in the open group underwent bilateral reimplantation. Gender distribution was identical between groups. There was a significant difference in age at surgery (RALUR: 74 months, Open: 52 months, p Z 0.034) and perioperative weight (RALUR: 27.2 kg, Open: 18.2 kg, p Z 0.042). VUR grade and incidence of duplicated systems were similar between groups. One patient in each group had previously failed treatment with endoscopic injection. Operative details are presented in Table 2. There were no intraoperative complications in either group. Operative times were longer for both unilateral and bilateral operations in the RALUR groups than in the open groups (Unilateral: RALUR: 165 min, Open: 109 min, p < 0.001, Bilateral: RALUR: 227 min, Bilateral: 135 min, p < 0.001) (Fig. 1). The mean actual in-console operative time for the RALUR was recorded as 55 min for unilateral, and 94 min for bilateral RALUR. EBL, days with Foley catheter, and length of hospital stay were similar between all groups. There was a significantly lower postoperative narcotic analgesic (RALUR: 0.14 mg/kg, Open: 0.25 mg/kg, p Z 0.021) and total postoperative as needed analgesic dose (RALUR: 4.0, Open: 7.5, p Z 0.020) requirement in the RALUR group as presented in Table 3 and Fig. 2. One patient in the RALUR group and seven patients in the open group received non-narcotic pain medication in the form of ketorolac. To account for these, the total number of as needed doses of any analgesic was calculated. The use of non-narcotics was significantly lower in the RALUR group (RALUR: 4.00 doses, Open 7.50 doses, p Z 0.020). Follow up data are presented in Table 4. There were two febrile urinary tract infections in each group postoperatively. A single case of persistent VUR was diagnosed in the open group, and 12 patients (60%) undergoing VCUG in the RALUR did not have persistent VUR, though the patients in the open group have been observed over a longer median time period (RALUR: 39 months, Open: 52 months, p < 0.001). Surgical complications as classified by the ClavieneDindo classification system [8] are presented in Table 5. While there was no significant difference in the overall rate of surgical complications, the complications in
Table 1
Patient demographics.
Postoperative course Patients in both groups had identical access to ad libitum analgesia as needed throughout the inpatient postoperative period. All patients left the operating room with an indwelling urinary catheter. The catheter was removed on the morning of postoperative day 1. Post-void residual bladder volume was measured in all patients and ensured to be less than 20% of expected based on bladder capacity prior to discharge. All patients underwent renal ultrasound at 1 month. Patients remained on antibiotic prophylaxis 1 month postoperatively until the renal ultrasound was completed.
No. patients M:F ratio Mean age at surgery (mo) Mean weight (kg) Unilat:bilat ratio Mean VUR grade: Overall Unilateral Bilateral No. with duplicated system No. with previous treatment
Robot
Open
p Value
20 1:9 74 27.22 1:3
20 1:9 52 18.22 3:7
1 0.034 0.043 0.330
2.84 3.07 2.50 5 1
3.13 3.21 3.04 6 1
0.230 0.613 0.200 0.716 1
Please cite this article in press as: Schomburg JL, et al., Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery, Journal of Pediatric Urology (2014), http://dx.doi.org/10.1016/j.jpurol.2014.02.013
+
MODEL
4
J.L. Schomburg et al. Table 2
Table 3
Operative and postoperative outcomes.
Mean procedure time (min) Unilateral Bilateral Estimated blood loss (mL) Unilateral Bilateral Days with urinary catheter Length of stay (days) Postoperative urinary retention Persistent VUR Mean follow-up (mo)
Robot
Open
p Value
165 227 4.5 4.3 5.2 0.85 1.05 1 0 13
109 134.5 8.1 4.6 16.2 1.05 1.4 3 1 27
MODEL
Journal of Pediatric Urology (2014) xx, 1e5
Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery John L. Schomburg, Ken Haberman, Katie H. Willihnganz-Lawson, Aseem R. Shukla* Section of Pediatric Urology, University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN, USA Received 30 August 2013; accepted 25 February 2014
KEYWORDS Vesicoureteral reflux; Robot-assisted laparoscopy; Ureteral reimplantation
Abstract Objective: The aim was to report a single surgeon’s experience comparing open and robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) to treat vesicoureteral reflux (VUR). Subjects and methods: We retrospectively reviewed the outcomes of RALUR and open extravesical ureteral reimplantations consecutively performed by a single surgeon between January 2008 and December 2010 using the da Vinci Surgical System. Both groups of patients were subjected to identical pre- and postoperative care protocols. Results: During the defined study interval, 20 open and 20 RALUR procedures were completed by a single surgeon at our institution. Gender and VUR grade were similar in both cohorts. Operative times were longer in the RALUR group, but postoperative opioid use (morphine equivalents) was significantly lower in the RALUR group (RALUR: 0.14 mg/kg, open: 0.25 mg/kg, p Z 0.021). There was no significant difference in estimated blood loss (EBL) or length of hospitalization (LOH). The overall rate of surgical complications was similar; however, the complications in the open group tended to be less severe than those occurring in the RALUR group. On follow-up, after a median of 52 months for open surgery and 39 months for RALUR, two children had developed a febrile urinary tract infection in both groups, of which one in the open group had persistent VUR. Conclusion: This single-surgeon experience of open and initial experience with RALUR performed with the same surgical technique on consecutive cohorts with identical post-surgical
* Corresponding author. The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA. Tel.: þ1 215 590 7889; fax: þ1 215 590 3985. E-mail address: [email protected] (A.R. Shukla). http://dx.doi.org/10.1016/j.jpurol.2014.02.013 1477-5131/ª 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
Please cite this article in press as: Schomburg JL, et al., Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery, Journal of Pediatric Urology (2014), http://dx.doi.org/10.1016/j.jpurol.2014.02.013
+
MODEL
2
J.L. Schomburg et al. care protocol allows a comparative analysis of outcomes for a surgeon transitioning to RALUR. The RALUR reduces postoperative analgesic requirements while yielding similar clinical outcomes as the open technique. ª 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
Introduction
Study design and data collection
It is estimated that 1e3% of children, and up to 30% of those with urinary tract infections, suffer from vesicoureteral reflux (VUR) [1]. Left untreated, symptomatic VUR can be a risk for recurrent pyelonephritis and its associated morbidity. While several treatment alternatives exist for VUR, the gold standard surgical alternative for clinically significant VUR remains open surgery with either an intravesical or extravesical ureteral reimplantation. With the goal of reducing the morbidity associated with open surgery, laparoscopic and robot-assisted laparoscopic (RAL) procedures in children have been described as viable minimally invasive alternatives to open surgery for many pediatric urologic conditions. For various procedures, patients undergoing RAL are experiencing shorter hospital stays, decreased pain medication requirements, and improved cosmesis when compared to patients who underwent open surgery [2,3]. The laparoscopic extravesical ureteral reimplantation was first described in 1994 [4], and was later shown to produce similar results as the open technique while reducing postoperative discomfort [5]. However, this technique was not widely adopted as the approach is technically challenging [6]. The same technique was later adapted for use with the surgical robot, overcoming many of those challenges. Initial experience with the robotassisted laparoscopic ureteral reimplantation (RALUR) showed high rates of VUR resolution with few complications, including a low rate of urinary retention [2,7]. However, these early feasibility studies did not include a control group. By comparing a single surgeon’s experience with the open and RAL approaches to the extravesical ureteral reimplantation, we sought to compare treatment outcomes and the feasibility of transitioning to RALUR in a pediatric urology practice.
After obtaining approval from the University of Minnesota Institutional Review Board, patient data were obtained retrospectively from the electronic medical record. Preoperative evaluation included voiding cystourethrogram (VCUG) to assess the grade of VUR as well as renal ultrasound or nuclear medicine scan to evaluate for renal scarring, atrophy and differential function. While nuclear renography was obtained preoperatively in some patients, there was no absolute criteria for consideration for surgery. Parent preference played a key role in decision making prior to surgery. Every child in the open and RALUR groups had experienced at least one febrile urinary tract infection prior to surgery, and all children had VUR present on VCUG. While adjunctive studies such as a DMSA scan were obtained for patients preoperatively, there were no absolute criteria by DMSA prior to consideration for surgery. Parent preference played a key role in decision-making process prior to surgery. All parents were appropriately counseled regarding all management options, including observation with or without prophylactic antibiotics, endoscopic injection of bulking agents, or ureteral reimplantation. Since the adoption of the RALUR at our institution in 2008, the procedure is offered to all patients considered candidates for ureteral reimplantation over 18 months of age. Children under that age are typically offered only the open approach due to surgeon preference. An open approach is also preferred in cases of a ureterocele or likely need for ureteral tapering, but those patients were not included in this analysis. Operative times represent total in-room time for both open and RALUR groups, including port placement, robot docking, and console times for the RALUR group. EBL was as recorded in the operative reports. Pain medication data were collected from inpatient medication administration reports. The majority of patients were given hydrocodone orally as needed and acetaminophen. Rare patients were given intravenous morphine, intravenous dilaudid, or ibuprofen orally. Total narcotic administered was calculated and was converted using a correction factor (0.5 mg of intravenous hydrocodone or 6.66 mg of intravenous dilaudid) to IV morphine equivalents, which was then standardized for patient weight. Non-narcotic pain medication was also included in the analysis. As all pain medications were prescribed as needed, the total number of pain medication dosages of any type was also totaled for each patient. No patients received an epidural or patient controlled analgesia. Follow-up data were obtained from the electronic medical record. While the only way to definitively confirm resolution of reflux is with postoperative VCUG, the retrospective nature of this study precludes this as it is not our
Materials and methods Patient selection A total of 20 patients underwent RALUR by a single surgeon (AS) at our institution during the defined study period (January 2008 to December 2010). A group of 23 consecutive patients undergoing extravesical ureteral reimplantation by the same surgeon during the same time period was identified; three patients with previous or concomitant intra-abdominal surgery were excluded. All children undergoing unilateral or bilateral intravesical ureteral reimplants during the same time period were also excluded from analysis.
Please cite this article in press as: Schomburg JL, et al., Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery, Journal of Pediatric Urology (2014), http://dx.doi.org/10.1016/j.jpurol.2014.02.013
+
MODEL
Robot-assisted laparoscopic ureteral reimplantation standard practice to obtain VCUG in each patient following surgery. Since the success of the open and RALUR techniques we utilized were previously confirmed both internally and in previous reports [7] with routine postoperative VCUGs, a VCUG was offered to all families, but obtained postoperatively only upon family preference or in instances where patients developed a febrile urinary tract infection following surgery. Operative success was therefore defined as absence of febrile urinary tract infections; where VCUG was obtained, success was defined by radiographic evidence of VUR resolution. Complications were identified from the medical record and graded with the ClavieneDindo classification system [8]. Statistical analysis was performed using Microsoft Excel. Data were analyzed using paired, two-tailed t tests. Statistical significance was defined as p < 0.05.
Surgical technique Our RALUR technique is similar to what has previously been described in the literature [7], using the same fundamental principles utilized for an open extravesical reimplantation, with the exception that a transperitoneal approach is used to access the ureter and bladder. Cystoscopy is performed only when ectopic ureteral insertion is suspected. For the robotic camera port, an 8 or 10 mm port is inserted just inferior to the umbilicus. Two 5 mm robotic ports are placed on the right and left midclavicular line approximately 1 cm inferior to the umbilicus. No fourth, assistant port, is placed. The da Vinci Surgical System is docked in standard fashion. The ureters are identified distal to the round ligament in females and vas deferens in males, and mobilized to their insertion in the bladder. Care is taken to minimize the use of electrocautery lateral to this insertion point. The detrusor is incised and separated using sharp dissection and intermittent monopolar cautery with the endowrist cautery hook, leaving the mucosa intact. A detrusor incision to ureteral diameter ratio of 4 or 5:1 is maintained. To aid in elongating the detrusor trough during detrusorrhaphy, a 2.0 polypropylene suture on a Keith needle (or straightened SH needle for smaller patients) is passed suprapubically into the peritoneal space and used to hitch the bladder anteriorly. A series of simple interrupted 5-0 polydioxanone stitches are used to close the detrusor over the ureter, after which the retraction suture is relaxed.
3
Results Patient demographics and clinical features are presented in Table 1. Five patients in the RALUR and six in the open group underwent bilateral reimplantation. Gender distribution was identical between groups. There was a significant difference in age at surgery (RALUR: 74 months, Open: 52 months, p Z 0.034) and perioperative weight (RALUR: 27.2 kg, Open: 18.2 kg, p Z 0.042). VUR grade and incidence of duplicated systems were similar between groups. One patient in each group had previously failed treatment with endoscopic injection. Operative details are presented in Table 2. There were no intraoperative complications in either group. Operative times were longer for both unilateral and bilateral operations in the RALUR groups than in the open groups (Unilateral: RALUR: 165 min, Open: 109 min, p < 0.001, Bilateral: RALUR: 227 min, Bilateral: 135 min, p < 0.001) (Fig. 1). The mean actual in-console operative time for the RALUR was recorded as 55 min for unilateral, and 94 min for bilateral RALUR. EBL, days with Foley catheter, and length of hospital stay were similar between all groups. There was a significantly lower postoperative narcotic analgesic (RALUR: 0.14 mg/kg, Open: 0.25 mg/kg, p Z 0.021) and total postoperative as needed analgesic dose (RALUR: 4.0, Open: 7.5, p Z 0.020) requirement in the RALUR group as presented in Table 3 and Fig. 2. One patient in the RALUR group and seven patients in the open group received non-narcotic pain medication in the form of ketorolac. To account for these, the total number of as needed doses of any analgesic was calculated. The use of non-narcotics was significantly lower in the RALUR group (RALUR: 4.00 doses, Open 7.50 doses, p Z 0.020). Follow up data are presented in Table 4. There were two febrile urinary tract infections in each group postoperatively. A single case of persistent VUR was diagnosed in the open group, and 12 patients (60%) undergoing VCUG in the RALUR did not have persistent VUR, though the patients in the open group have been observed over a longer median time period (RALUR: 39 months, Open: 52 months, p < 0.001). Surgical complications as classified by the ClavieneDindo classification system [8] are presented in Table 5. While there was no significant difference in the overall rate of surgical complications, the complications in
Table 1
Patient demographics.
Postoperative course Patients in both groups had identical access to ad libitum analgesia as needed throughout the inpatient postoperative period. All patients left the operating room with an indwelling urinary catheter. The catheter was removed on the morning of postoperative day 1. Post-void residual bladder volume was measured in all patients and ensured to be less than 20% of expected based on bladder capacity prior to discharge. All patients underwent renal ultrasound at 1 month. Patients remained on antibiotic prophylaxis 1 month postoperatively until the renal ultrasound was completed.
No. patients M:F ratio Mean age at surgery (mo) Mean weight (kg) Unilat:bilat ratio Mean VUR grade: Overall Unilateral Bilateral No. with duplicated system No. with previous treatment
Robot
Open
p Value
20 1:9 74 27.22 1:3
20 1:9 52 18.22 3:7
1 0.034 0.043 0.330
2.84 3.07 2.50 5 1
3.13 3.21 3.04 6 1
0.230 0.613 0.200 0.716 1
Please cite this article in press as: Schomburg JL, et al., Robot-assisted laparoscopic ureteral reimplantation: A single surgeon comparison to open surgery, Journal of Pediatric Urology (2014), http://dx.doi.org/10.1016/j.jpurol.2014.02.013
+
MODEL
4
J.L. Schomburg et al. Table 2
Table 3
Operative and postoperative outcomes.
Mean procedure time (min) Unilateral Bilateral Estimated blood loss (mL) Unilateral Bilateral Days with urinary catheter Length of stay (days) Postoperative urinary retention Persistent VUR Mean follow-up (mo)
Robot
Open
p Value
165 227 4.5 4.3 5.2 0.85 1.05 1 0 13
109 134.5 8.1 4.6 16.2 1.05 1.4 3 1 27
