title: Bi-Institutional Comparison of Robot-Assisted Laparoscopic Versus Open Ureteroureterostomy in the Pediatric Population.
abstract: OBJECTIVE
  Ureteroureterostomy (UU) is a useful surgical option for the management of duplication anomalies as well as obstructed single system ureters for children. We aimed to evaluate the safety, efficacy, and outcomes of robot-assisted laparoscopic UU (RALUU) compared with open UU (OUU) in the pediatric population.
  
  
  METHODS
  A retrospective review was performed at two institutions including six surgeons' experience with all cases of RALUU and OUU from January 2005 to June 2014. Indications for a surgical procedure included duplex systems with an upper pole ectopic ureter, obstructed ureterocele or lower pole vesicoureteral reflux, and obstruction in a single system. Transureteroureterostomy, laparoscopic UU, and major reconstruction cases where UU was the secondary procedure were excluded.
  
  
  RESULTS
  There were 25 RALUU and 19 OUU cases included. All cases involved duplex systems except two proximal to distal anastomoses in single system obstructed kidneys. RALUUs were more likely to be performed proximally (P = 0.01) and with the use of cystoscopy and stent placement (P = <0.0001). Operative times and estimated blood loss were similar between the two groups. Postoperative complications included four febrile urinary tract infections in each group, one recurrence of nonfebrile urinary tract infection in the open group, and one postoperative obstruction at the ureterovesical junction because of attempted stent placement necessitating nephrostomy tube placement in the open group. This OUU patient was the only one to demonstrate more severe hydronephrosis after surgery on initial follow-up imaging that was again unrelated to the open UU procedure. RALUU had shorter hospital stays by 0.5 days (P = 0.04).
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic UU is a safe and effective alternative to open UU in children with duplication anomalies and single system obstructed ureters. Operative times and complication rates were comparable with slightly shorter length of hospitalization in robotic cases.
authors.affiliation: 1 Department of Urology, Children's National Medical Center , Washington, District of Columbia.
authors.forename: Nora G
authors.initials: NG
authors.lastname: Lee
authors.affiliation: 2 Department of Urology, University of Virginia Medical Center , Charlottesville, Virginia.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Corbett
authors.affiliation: 3 Department of Urology, George Washington University Hospital , Washington, District of Columbia.
authors.forename: Kaitlan
authors.initials: K
authors.lastname: Cobb
authors.affiliation: 4 Department of Urology, Mayo Clinic , Rochester, Minnesota.
authors.forename: George C
authors.initials: GC
authors.lastname: Bailey
authors.affiliation: 5 Department of Urology, Penn State Hershey Medical Center , Hershey, Pennsylvania.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Burns
authors.affiliation: 1 Department of Urology, Children's National Medical Center , Washington, District of Columbia.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Peters
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009403:Nephrostomy, Percutaneous; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014513:Ureter / Q000002:abnormalities / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*; D014518:Ureterocele / Q000150:complications / Q000601:surgery*; D014519:Ureterostomy / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery*