Comparison of Robot-assisted Laparoscopic Extravesical Ureteral Reimplantation for Primary Vesicoureteral Reflux in Infants Under One Year of Age and Older Children

Xiaowei Zhang; Tian Tao; Pin Li; Yang Zhao; Hualin Cao; Yuandong Tao; Lifei Ma; Xiaoguang Zhou; Hongshuai Jia; Yangyang Wu; Ran Zhuo; Guang Yue; Yanpei Yang; Guilong Chen; Xiaoyu Yi; Huixia Zhou

doi:10.1016/j.jpedsurg.2024.162114

Comparison of Robot-assisted Laparoscopic Extravesical Ureteral Reimplantation for Primary Vesicoureteral Reflux in Infants Under One Year of Age and Older Children

J Pediatr Surg. 2024 Dec 19;60(3):162114. doi: 10.1016/j.jpedsurg.2024.162114. Online ahead of print.

Authors

Xiaowei Zhang¹, Tian Tao², Pin Li², Yang Zhao², Hualin Cao³, Yuandong Tao², Lifei Ma², Xiaoguang Zhou², Hongshuai Jia¹, Yangyang Wu¹, Ran Zhuo⁴, Guang Yue¹, Yanpei Yang¹, Guilong Chen¹, Xiaoyu Yi², Huixia Zhou⁵

Affiliations

¹ Department of Pediatric Urology, Department of Senior Pediatrics, The Seventh Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China; Medical School of Chinese People's Liberation Army (PLA), Beijing, China.
² Department of Pediatric Urology, Department of Senior Pediatrics, The Seventh Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
³ Department of Urology, Nan Xi Shan Hospital of Guangxi Zhuangzu Autonomous Region, Guilin, China.
⁴ Department of Pediatric Urology, Department of Senior Pediatrics, The Seventh Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China; Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁵ Department of Pediatric Urology, Department of Senior Pediatrics, The Seventh Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China; Medical School of Chinese People's Liberation Army (PLA), Beijing, China. Electronic address: huixia99999@163.com.

PMID: 39740279
DOI: 10.1016/j.jpedsurg.2024.162114

Abstract

Purpose: To assess the surgical outcomes of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation (RALUR-EV) in infants under one year of age with primary vesicoureteral reflux (VUR) as compared to older children.

Materials and methods: A retrospective analysis was conducted on 48 children with VUR who underwent unilateral or bilateral RALUR-EV between June 2018 and December 2022. Patients were divided into two groups: Group A (25 infants under one year) and Group B (23 children over one year). Preoperative evaluations included voiding cystourethrogram (VCUG), diuretic renography, ultrasonography, magnetic resonance urography, and urodynamic studies. Standard follow-up was conducted postoperatively, and both the resolution of reflux and any complications were meticulously documented.

Results: All procedures were completed using the Da Vinci Surgical System without conversion to open surgery or major intraoperative complications. Group A had significantly smaller bladder capacities compared to Group B (70 [60, 90] ml vs. 150 [90, 200] ml, P <0.001) and a higher proportion of refractory febrile UTIs preoperatively (88.00 % vs. 60.87 %, P = 0.030). No significant differences in Operation time, estimated blood loss, or postoperative complications were observed between the groups. The success rates of reflux resolution were 96.00 % in Group A and 95.65 % in Group B. The length of hospital stay was significantly shorter in Group A (5 [4, 6] days vs. 7 [6, 10] days, P = 0.001).

Conclusion: RALUR-EV for the treatment of VUR in infants under one year of age is safe and effective. Compared to older children, the procedure does not increase intraoperative risks, and postoperative outcomes are comparable.

Keywords: Infants; Laparoscopy; Robotics; Ureteral reimplantation; Vesicoureteral reflux.