title: Simultaneous bilateral robotic-assisted laparoscopic procedures in children.
abstract: Our main objective is to report the feasibility of performing simultaneous robotic-assisted laparoscopic (RAL) heminephrectomy with contralateral ureteroureterostomy in children with bilateral duplicated systems. Three female children with bilateral congenital renal/ureteral anomalies underwent concurrent RAL simultaneous unilateral partial nephrectomy with ureterectomy and contralateral ureteroureterostomy with redundant ureterectomy using a four/five-port approach. Mean age at repair was 32.9 months (range 7-46 months) and mean weight was 13.7 kg (range 10.4-13.6 kg). The RAL heminephroureterectomy and contralateral ureteroureterostomy were performed via a four-port approach (five ports in one patient), and the patients were repositioned and draped when moving to the other side. Mean operative time was 446 min (range 356-503 min). Mean estimated blood loss was 23.3 cc (range 10-50 cc). Postoperative length of stay for two patients was 2 days and 1 day for one patient (mean = 1.7 days). Mean length of follow-up was 18.3 months (range 7-36 months). No significant intraoperative or postoperative complications occurred for any of the three patients. Two children had no hydronephrosis on postoperative imaging in follow-up, and one child had a small stable, residual pararenal fluid collection on the side of heminephrectomy. Two patients underwent postoperative ureteral stent removal under general anesthesia. In children with bilateral duplicated urinary tract with ureterocele, ectopic ureter, and/or vesicoureteral reflux, laparoscopic repair with robotic assistance can be accomplished safely in a single operative procedure with a short hospital stay.
authors.affiliation: Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Kapoor
authors.affiliation: Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA. jack.s.elder@gmail.com.|Division of Pediatric Urology, MassGeneral Hospital for Children, 55 Fruit Street, WRN 11, Boston, MA, 02114, USA. jack.s.elder@gmail.com.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Elder
mesh_terms: D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014513:Ureter / Q000002:abnormalities; D014519:Ureterostomy / Q000009:adverse effects / Q000379:methods*
keywords: Bilateral; Duplicated ureter; Heminephrectomy; Laparoscopy; Pediatric; Robotic; Vesicoureteral reflux