title: Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair.
abstract: OBJECTIVE
  Robotic surgery has evolved from simple extirpative surgery to complex reconstructions even in infants. Data are lacking comparing surgical and direct costs to open approaches. We describe the feasibility, salient tips and outcomes of robot-assisted laparoscopic pyeloplasty compared to an open approach.
  
  
  METHODS
  We evaluated patients undergoing open pyeloplasty or robot-assisted laparoscopic pyeloplasty. Ten patients in each group met inclusion criteria.
  
  
  RESULTS
  Mean patient age was 3.31 months in the open group and 7.3 months in the robotic group (p=0.02). Postoperative outcomes including length of stay (2.2 vs 2.1 days), estimated blood loss (6.5 vs 7.6 ml), days to regular diet (1 vs 1.1) and days to Foley catheter removal (1.3 vs 1.3) were similar between the open and robotic groups. Total operating time (199 vs 242 minutes) was significantly longer in the robotic group. Postoperative improvement in hydronephrosis was identical in both groups. Direct costs, excluding amortization, robotic cost, maintenance and depreciation, were $4,410 in the open group and $4,979 in the robotic group (p=0.10).
  
  
  CONCLUSIONS
  In our preliminary experience robotic pyeloplasty in infants is feasible and safe. The immediate outcomes are similar to those of an open approach. The robotic technique in infants currently has the benefits of improved esthetic appearance, improved pain control and similar direct costs compared to the traditional open approach.
authors.affiliation: Department of Surgery, Division of Urology, University of Chicago School of Medicine and Biological Sciences, and Comer Children's Hospital, Chicago, Illinois.
authors.forename: Pankaj P
authors.initials: PP
authors.lastname: Dangle
authors.forename: James
authors.initials: J
authors.lastname: Kearns
authors.forename: Blake
authors.initials: B
authors.lastname: Anderson
authors.forename: Mohan S
authors.initials: MS
authors.lastname: Gundeti
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012371:Robotics; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: CP-U; MAG-3; OP; POD; RAL-P; UPJO; cutaneous pyeloureteral stent; hydronephrosis; infant; kidney pelvis; mercaptoacetyltriglycine; open pyeloplasty; postoperative day; robotic pyeloplasty; robotics; ureteropelvic junction obstruction; urologic surgical procedures