Early results of robot assisted laparoscopic lithotomy in adolescents.
OBJECTIVE
The treatment of large stone burdens in children is difficult and often requires multiple procedures using a combination of therapies. Recently, laparoscopy has been shown to be effective in the management of larger stone burdens. We report our experience with robot assisted laparoscopic lithotomy in adolescents, and describe our technique.


METHODS
We retrospectively reviewed our experience with robot assisted laparoscopic pyelolithotomy in 5 patients operated on between 2002 and 2005. Mean patient age at surgery was 16.6 years, and mean followup was 15.4 months.


RESULTS
Cystine was the etiology in 4 patients with staghorn stones. The remaining patient had calcium oxalate stones and concurrent ureteropelvic junction obstruction. After pyelotomy stones were removed by a robotic grasper or by a flexible cystoscope introduced through a robotic port. One of the patients had an indwelling ureteral stent placed preoperatively, while 4 had stents placed robotically intraoperatively. Mean operative time was 315.4 minutes (range 165.0 to 462.0), and mean estimated blood loss was 19.0 ml (0.0 to 50.0). Mean hospital stay was 3.8 days (range 2.3 to 5.7), and mean narcotic usage was 2.1 mg/kg morphine (1.5 to 3.5). One patient with a cystine staghorn calculus required conversion to an open procedure because of inability to remove the stone. Of the 4 cases completed robotically 3 were rendered stone-free and 1 had a residual 6 mm lower pole stone.


CONCLUSIONS
The early results of robot assisted laparoscopic lithotomy reveal that the procedure is safe and efficacious. Further prospective studies comparing other minimally invasive procedures used for similar stone burdens are needed to determine the benefits of this procedure and its role in stone management.
Lee
Richard S
RS
Department of Urology, Children's Hospital Boston, Boston, Massachusetts, USA.
Passerotti
Carlo C
CC
Cendron
Marc
M
Estrada
Carlos R
CR
Borer
Joseph G
JG
Peters
Craig A
CA
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome