title: Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults.
abstract: OBJECTIVE
  Laparoscopic pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time.
  
  
  METHODS
  We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed.
  
  
  RESULTS
  Mean operative time and length of hospitalization decreased significantly by the end of the study. At a mean followup of 31.7 months the primary success rate was 96% (hydronephrosis was improved in 85% of patients and stable in 11%). The complication rate was 11%, and recurrent obstruction requiring redo robotic assisted laparoscopic pyeloplasty or open pyeloplasty developed in 3% of patients. Success rate and complication rate were unchanged during the study period.
  
  
  CONCLUSIONS
  This study confirms that even within the confines of a pediatric urology training program successful collaboration between robotic surgeons, surgical nurses and anesthesiologists can lead to shorter operative times and hospital stays. Long-term surgical success and complication rates were comparable to open surgery.
authors.affiliation: Department of Urology, Robotic Surgery, Research and Training Center, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Minnillo
authors.forename: Jose A S
authors.initials: JA
authors.lastname: Cruz
authors.forename: Rogerio H
authors.initials: RH
authors.lastname: Sayao
authors.forename: Carlo C
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Constance S
authors.initials: CS
authors.lastname: Houck
authors.forename: Petra M
authors.initials: PM
authors.lastname: Meier
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult