title: Multi-Institutional Review of Outcomes and Complications of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation for Treatment of Primary Vesicoureteral Reflux in Children.
abstract: Robot-assisted laparoscopic extravesical ureteral reimplantation has been proposed as a minimally invasive alternative to open ureteral reimplantation for correcting primary vesicoureteral reflux in children. However, in the current literature there are conflicting data regarding the safety and efficacy of this approach. Amid ongoing debate we analyzed outcomes and complications from this procedure in a large multi-institutional cohort.
  
  
  
  We reviewed the records of children who underwent robot-assisted laparoscopic extravesical ureteral reimplantation at 9 academic centers from 2005 to 2014. Radiographic failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram. Complications were graded using the Clavien-Dindo scale.
  
  
  
  A total of 260 patients (363 ureters) underwent robot-assisted laparoscopic extravesical ureteral reimplantation for primary vesicoureteral reflux during the study period. The cohort included 90 patients with either duplex ureter (42), failed endoscopic treatment (40) or concomitant diverticulectomy (8). Of the 280 ureters with postoperative voiding cystourethrogram or radionuclide cystogram available radiographic resolution was seen in 246 (87.9%). There were 25 complications overall (9.6%), with 7 grade 3 complications (2.7%) and no grade 4 or 5 complications. Four patients (3.9%) had transient urinary retention following bilateral reimplantation.
  
  
  
  Robot-assisted laparoscopic extravesical ureteral reimplantation has a low complication rate consistent with published series of open ureteral reimplantation. Radiographic success rates are approaching those of the open procedure but continue to fall short of the gold standard approach. These findings necessitate critical thinking regarding potential technique improvements and further prospective investigation into the efficacy of this procedure.
authors.affiliation: University of Chicago, Chicago, Illinois.
authors.forename: William R
authors.initials: WR
authors.lastname: Boysen
authors.affiliation: Seattle Children's Hospital, Seattle, Washington.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Ellison
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut.
authors.forename: Christina
authors.initials: C
authors.lastname: Kim
authors.affiliation: Texas Children's Hospital, Houston, Texas.
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Paul
authors.initials: P
authors.lastname: Noh
authors.affiliation: Indiana University, Indianapolis, Indiana.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Whittam
authors.affiliation: University of Oklahoma, Norman, Oklahoma.
authors.forename: Blake
authors.initials: B
authors.lastname: Palmer
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Aseem
authors.initials: A
authors.lastname: Shukla
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirsch
authors.affiliation: University of Chicago, Chicago, Illinois. Electronic address: mgundeti@surgery.bsd.uchicago.edu.
authors.forename: Mohan S
authors.initials: MS
authors.lastname: Gundeti
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
keywords: minimally invasive surgical procedures; replantation; robotic surgical procedures; ureter; vesico-ureteral reflux