Robot-assisted (RA-)pediatric surgery: pyeloplasty with the Da Vinci robotic system

Background. In other countries robot-assisted (RA) surgery and especially RA urology in pediatric surgery is already an important alternative to conventional interventions (open, laparoscopic, laparoscopically assisted); however, only few studies have been published in Germany. Objective In the sense of a comparative series, the first cases of RA pyeloplasty carried out in this clinic were compared with cases using conventional laparoscopically assisted (LAA) interventions and evaluated with respect to the international literature. Material and methods. The first 13 cases of RA pyeloplasty were retrospectively compared with 14 conventional LAA Anderson-Hynes procedures selected based on patient age, with respect to operative time, length of hospital stay, age, complication rate and relapses. The LAA operations were carried out laparoscopically, only the placement of an anastomosis was extracorporeally completed through a small lateral incision. The RA interventions were carried out completely laparoscopically. Results. The duration of surgery showed no significant difference (111.54min vs. 117.64min). The length of hospital stay was significantly shorter in the RA group (5.85 days vs. 10.0 days). The mean age for patients undergoing RA surgery was 52.23 months and for the LAA group 30.29 months. The complication rate was 15.38% (hydronephrosis, paralytic ileus, dislocated peridural catheter and prolapse of the greater omentum) and the recurrence rate 7.69% for RA surgery. For the LAA group of patients the complication rate was 7.14% (dislocation of the stent) and 14.28% for recurrences. Conclusion. In comparison with international data, the first cases of RA pyeloplasty in our clinic showed similar values regarding operation time, complication rate and recurrence rate. The clinical outcomes for both procedures were similar and time saving in RA surgery was not significant compared to LAA. In contrast, the length of hospital stay was significantly shorter after RA surgery but is described as even shorter in the international literature. Overall, RA pyeloplasty is a valuable alternative to LAA interventions.