title: Robotic-assisted partial nephrectomy in duplicated collecting systems in the pediatric population: techniques and outcomes.
abstract: OBJECTIVE
  We present our experience with pediatric robotic-assisted laparoscopic partial nephrectomy of a nonfunctioning moiety in a duplicated system (RALPN), comparing techniques and outcomes with those previously reported in the literature. To our knowledge, this is the largest series of this surgical procedure to date.
  
  
  METHODS
  We retrospectively reviewed all pediatric patients at our institution that had undergone RALPN from 2006 to 2012.
  
  
  RESULTS
  Twenty-one patients underwent RALPN between 2006 and 2012. Mean patient age was 4.1 years. Mean operative time was 301 min. Mean estimated blood loss was 36 ml. Mean length of stay was 38 h. The majority of cases were performed with three laparoscopic ports. At initial follow-up ultrasound 6/21 (29%) demonstrated a fluid collection. The majority of these collections occurred in cases where the resection defect was not closed intraoperatively (42% of cases vs. 11% of cases). All fluid collections were asymptomatic and managed conservatively.
  
  
  CONCLUSIONS
  RALPN is associated with low complication rates. The robotic system allows for the use of only two small robotic working ports in most cases. Postoperative fluid collections may be prevented by formal closure of the polar defect, but fluid collections that do occur can be followed conservatively.
authors.affiliation: Department of Urology, University of Virginia Health System, P.O. Box 800422, Charlottesville, VA 22908, USA. Electronic address: Matthew.D.Mason@vanderbilt.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Mason
authors.affiliation: Department of Urology, University of Virginia Health System, P.O. Box 800422, Charlottesville, VA 22908, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Anthony Herndon
authors.affiliation: Department of Urology, University of Virginia Health System, P.O. Box 800422, Charlottesville, VA 22908, USA.
authors.forename: L I
authors.initials: LI
authors.lastname: Smith-Harrison
authors.affiliation: Department of Urology, University of Virginia Health System, P.O. Box 800422, Charlottesville, VA 22908, USA; Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC 20010, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Peters
authors.affiliation: Department of Urology, University of Virginia Health System, P.O. Box 800422, Charlottesville, VA 22908, USA.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Corbett
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004219:District of Columbia; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007685:Kidney Tubules, Collecting / Q000002:abnormalities* / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D012737:Sex Factors; D016896:Treatment Outcome; D014564:Urogenital Abnormalities / Q000175:diagnosis / Q000601:surgery
keywords: Duplicated kidney; Laparoscopic; Minimally invasive; Partial nephrectomy; Pediatric; Robotic