Volume 13, Supplement 1
Original Article / Published: April 2025
DOI: https://www.doi.org/10.57045/jemis/1310425.pp18-19
E. Atanasov, S. Andreev, I. A. Georgiev, M. Tsanev
Urology department, MHAT “VITA”, Sofia
Abstract
Introduction: Congenital hydronephrosis has an overall incidence of 1:1,500 and a ratio of male-to-female of 2:1 in newborns, occurring on the left side in 65% of the cases. Obstruction of the ureteropelvic junction is present in 1 of 1500 newborns. Causes can be intraureteral (dysplastic segment) and extraureteral (aberrant vessel, adhesions). Most commonly, the Anderson-Hynes technique is used as a surgical treatment. When performed in an open surgery, the access is retroperitoneal; in robot-assisted and laparoscopic techniques, we use transperitoneal access.
Objectives: Presentation of initial experience with laparoscopic and robot-assisted Anderson-Hynes transperitoneal pyeloplasty in children.
Materials and methods: From December 2021 to December 2024, transperitoneal laparoscopic pyeloplasty was performed on 200 children between five months and seventeen years of age with an obstruction proven with renal scintigraphy, decreased renal function and increasing anteroposterior diameter of the renal pelvis. 118 of the patents were boys and the other 82 – girls. 138 of the patients had left-sided hydronephrosis and 62 – right-sided. In 175 of the cases, the hydronephrosis was due to dysplasia of the ureteropelvic junction and in 25 of them, due to an external cause (an aberrant vessel). Pyeloplasty was performed using the Anderson-Hynes technique with one 5mm and two 3mm ports; 30-degree optics were used. For the same period, we performed two transperitoneal robot-assisted pyeloplasty 10 year 10-year-old boy with right-sided hydronephrosis caused by an aberrant vessel and 12 year 12-year-old boy with left-sided hydronephrosis due to dysplasia of the ureteropelvic junction. We used Da Vinci Xi.
Results: The average operative time was 110 minutes. All procedures were finished without conversion. No intraoperative complications were observed in all patients, and there was no need for intraoperative blood transfusion. In 5 patients, we found abdominal pain crises postoperatively for three days. Two of the operated patients needed a redo pyeloplasty one year after the first operation. In two kids, we performed blood transfusions postoperatively. No surgical drains were needed, and we used a “JJ” stent in all patients. The “JJ” stent was removed between the sixth and eighth week after surgery. Ultrasound was performed in the first month after removal of the “JJ” stent. The average hospital stay was 4,5 days. In both patients operated on using a robot-assisted technique, there were no intra- and postoperative complications. The average surgical time was 150 minutes, and the hospital stay was 4 days.
Conclusions: Robot-assisted pyeloplasty has many advantages over the laparoscopic approach, like ergonomics of the surgeon, better visualisation, larger volume of movement of the instruments, precise and fast suturing, but also has several disadvantages – financial cost, more and bigger size trocars needed. Laparoscopic and robot-assisted treatment of congenital hydronephrosis are modern methods recommended in the European guidelines and worldwide and are replacing open surgical techniques. When indicated, it has undisputable advantages.
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How to cite this article:
E. Atanasov, S. Andreev, I. A. Georgiev, M. Tsanev. Laparoscopic and robot-assisted pyeloplasty in children – tips and tricks. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2025; 13(1): 18-19
Corresponding author:
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VITA“ Hospital, Urology Department, Sofia
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