title: Robotic assisted laparoscopic ureteral reimplantation in children: case matched comparative study with open surgical approach.
abstract: OBJECTIVE
  Surgical treatment may be required in some patients with vesicoureteral reflux. With the recent development of robotic assistance, laparoscopic treatment of vesicoureteral reflux has gained popularity. We sought to evaluate our initial experience with pediatric robotic assisted laparoscopic intravesical and extravesical ureteral reimplantation, and to compare outcomes with the open technique.
  
  
  METHODS
  A retrospective chart review was performed on all patients who underwent robotic assisted laparoscopic ureteral reimplantation between 2007 and 2010. Comparisons were made with a case matched cohort of patients who underwent the open technique. The groups were compared using t tests for numerical variables and chi-square comparisons or Fisher's exact test for categorical variables. A Kaplan-Meier model was used to compare success rates.
  
  
  RESULTS
  A total of 19 patients underwent intravesical and 20 underwent extravesical robotic assisted laparoscopic ureteral reimplantation during the study period. They were compared to 22 patients undergoing intravesical and 17 undergoing extravesical open ureteral reimplantation. Although the robotic assisted approach was associated with a longer operative time (p <0.001), children undergoing intravesical robotic assisted reimplantation had a shorter duration of urinary catheter drainage, fewer bladder spasms and a shorter hospital stay compared to those undergoing the intravesical open technique (p <0.01). There were no significant differences in these parameters when comparing extravesical robotic assisted reimplantation to the extravesical open technique. Overall success rates were similar among patients who underwent robotic assisted laparoscopic ureteral reimplantation and open reimplantation (p >0.5).
  
  
  CONCLUSIONS
  Robotic assisted laparoscopic ureteral reimplantation offers similar success rates to the gold standard, open ureteral reimplantation. Future large scale studies will be required to define further the costs and benefits of robotic assisted laparoscopic ureteral reimplantation in the surgical treatment of vesicoureteral reflux.
authors.affiliation: Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
authors.forename: Giovanni S
authors.initials: GS
authors.lastname: Marchini
authors.forename: Young Kwon
authors.initials: YK
authors.lastname: Hong
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Minnillo
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.forename: Constance S
authors.initials: CS
authors.lastname: Houck
authors.forename: Petra M
authors.initials: PM
authors.lastname: Meier
authors.forename: Carlo C
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Kaplan
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D012092:Replantation; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*