title: Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation.
abstract: OBJECTIVE
  We performed a multi-institutional assessment of the outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for vesicoureteral reflux in children.
  
  
  METHODS
  We retrospectively reviewed the records of patients who underwent robot-assisted laparoscopic extravesical ureteral reimplantation as done by 1 of 5 surgeons at Children's Medical Center, Dallas, Texas, or Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, from 2010 to 2013. Procedure failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram and/or the need for reoperation. Multivariate logistic regression was done to identify possible risk factors for failure using STATA®, version 11.
  
  
  RESULTS
  A total of 61 patients (93 ureters) with a mean age of 6.7 years (range 0.6 to 18.0) underwent a procedure, of which 32 (52%) were bilateral. Ten patients (16%) underwent previous subureteral injection for vesicoureteral reflux. At a mean followup of 11.7 months the procedure was successful in 44 of 61 patients (72%). There were 14 cases of persistent vesicoureteral reflux (23%), 6 complications (10%) and 9 reoperations (11%). Multivariate logistic regression identified no factor that increased the risk of failure (p = 0.737).
  
  
  CONCLUSIONS
  Compared to the literature we found a notably lower success rate for robot-assisted laparoscopic extravesical ureteral reimplantation in the hands of 5 fellowship trained, robotically experienced pediatric urologists. More than 10% of patients required at least 1 reoperation for persistent vesicoureteral reflux or a surgical complication. Our experience suggests a higher complication rate and a lower success rate for robot-assisted laparoscopic ureteral reimplantation compared to the gold standard of open reimplantation.
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
authors.forename: Gwen M
authors.initials: GM
authors.lastname: Grimsby
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Moira E
authors.initials: ME
authors.lastname: Dwyer
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
authors.forename: Micah A
authors.initials: MA
authors.lastname: Jacobs
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ost
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Schneck
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Cannon
authors.affiliation: Texas Children's Hospital-Baylor College of Medicine, Houston, Texas. Electronic address: pcgargol@texaschildrens.org.
authors.forename: Patricio C
authors.initials: PC
authors.lastname: Gargollo
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D059032:Learning Curve; D016015:Logistic Models; D012092:Replantation / Q000379:methods*; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
keywords: laparoscopy; replantation; robotic; ureter; vesico-ureteral reflux