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Hiep T Nguyen - One of the best experts on this subject based on the ideXlab platform.
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long term experience and outcomes of robotic assisted laparoscopic Pyeloplasty in children and young adults
The Journal of Urology, 2011Co-Authors: Brian J Minnillo, Jose A S Cruz, Rogerio Sayao, Carlo C Passerotti, Constance S Houck, Petra M Meier, Joseph G Borer, David A Diamond, Alan B Retik, Hiep T NguyenAbstract:Purpose: Laparoscopic Pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic Pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time.Materials and Methods: We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic Pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed.Results: Mean operative time and length of hospitalizat...
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parental satisfaction after open versus robot assisted laparoscopic Pyeloplasty results from modified glasgow children s benefit inventory survey
The Journal of Urology, 2010Co-Authors: Drew A Freilich, Caleb P Nelson, Alan B Retik, Frank J Penna, Hiep T NguyenAbstract:Purpose: Since its inception, robot assisted laparoscopic Pyeloplasty has rapidly become the minimally invasive surgical intervention of choice for treating ureteropelvic junction obstruction at our institution. The large initial investment in robot assisted surgery is frequently justified by its association with improved optics and instrument articulation, decreased postoperative pain, shorter length of hospitalization and improved cosmesis. However, there are no data specifically showing patient satisfaction with robot assisted laparoscopic Pyeloplasty compared to traditional open surgery.Materials and Methods: A previously validated satisfaction survey (Glasgow Children's Benefit Inventory) with 14 additional questions specifically addressing postoperative satisfaction was mailed to all parents (as patient proxy) of children who had undergone open or robot assisted laparoscopic Pyeloplasty between January 2006 and December 2008.Results: A total of 78 parents responded (response rate 70%). All responses...
Thomas S Lendvay - One of the best experts on this subject based on the ideXlab platform.
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national trends in secondary procedures following pediatric Pyeloplasty
The Journal of Urology, 2016Co-Authors: Ryan S Hsi, Sarah K Holt, Thomas S Lendvay, John L Gore, Jonathan D HarperAbstract:Purpose: Although reported success rates after pediatric Pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric Pyeloplasty using a national employer based insurance database.Materials and Methods: Using the MarketScan® database we identified patients 0 to 18 years old who underwent Pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index Pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, Pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics.Results: We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-Pyeloplasty procedure. The first procedure was done within ...
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national trends in followup imaging after Pyeloplasty in children in the united states
The Journal of Urology, 2015Co-Authors: Ryan S Hsi, Sarah K Holt, Thomas S Lendvay, John L Gore, Jonathan D HarperAbstract:Purpose: Radiographic followup after Pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric Pyeloplasty.Materials and Methods: Using the MarketScan® database, we identified patients 0 to 18 years old undergoing Pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns.Results: We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive Pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6...
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comparison of the learning curve and outcomes of robotic assisted pediatric Pyeloplasty
The Journal of Urology, 2011Co-Authors: Mathew D Sorensen, Richard W Grady, Thomas S Lendvay, Catherine F Delostrinos, Michael H JohnsonAbstract:Purpose: We compared the learning curve and outcomes in children undergoing robotic assisted laparoscopic Pyeloplasty during the initiation of a robotic surgery program compared to the benchmark of open Pyeloplasty.Materials and Methods: The records of our first consecutive 33 children undergoing robotic assisted laparoscopic Pyeloplasty from 2006 to 2009 were retrospectively reviewed and compared to those of age and gender matched children who underwent open repair done by senior faculty surgeons before the initiation of our robotic surgery program. We compared operative time, complications, postoperative pain, length of stay and surgical success for 2 surgeons who adopted the robotic approach at an academic teaching institution.Results: We found no significant differences in length of stay, pain score or surgical success at a median followup of 16 months. The number of complications was similar and they tended to be early and technical in the robotic assisted laparoscopic Pyeloplasty group. Overall aver...
Pasquale Casale - One of the best experts on this subject based on the ideXlab platform.
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is peri operative urethral catheter drainage enough the case for stentless pediatric robotic Pyeloplasty
Journal of Pediatric Urology, 2015Co-Authors: Mark V Silva, Alison Levy, Julia B Finkelstein, Jason P Van Batavia, Pasquale CasaleAbstract:Summary Background The necessity for urinary diversion with trans-anastomotic ureteral stenting during Pyeloplasty is currently under debate. Performing a stentless repair could eliminate stent-related morbidity, including: stent migration, urinary tract infection, flank pain, and bladder spasms. In addition, there would be no need for a second procedure and associated anesthesia required for stent removal. This study describes the outcomes of robotic-assisted laparoscopic Pyeloplasty without use of a ureteral stent. Materials and methods An IRB-approved prospective database of all pediatric patients undergoing robotic Pyeloplasty from July 2012 to July 2014 at a single institution was reviewed. The ‘bypass Pyeloplasty’ or Anderson-Hynes dismembered Pyeloplasty (DP) technique was performed. In both groups, neither a ureteral stent nor an abdominal drainage catheter was utilized. Complications were recorded, including: postoperative pain, bladder spasms, fever, and urinary tract infections. Follow-up renal ultrasound was reviewed for hydronephrosis. Results Twenty-seven children (17 male, 10 female) with a mean age of 25 months (range 6–157 months) underwent robotic ureteral stentless Pyeloplasty during the study time period. The bypass Pyeloplasty technique was performed on 19 children (70%). Mean length of stay was 20.2 hours (range 11–46). No fever, urinary tract infections, or hematuria requiring intervention were experienced. Additionally, there were no reports of bladder spasms or pain requiring pharmacotherapy. The mean follow-up was 8 months (range 4–21). Pre-operative Society of Fetal Urology grading was 3.5 and 3.4 for the dismembered and bypass cohort, respectively, with improvements to 1.1 for both groups at 3 months. Postoperative renal ultrasound hydronephrosis resolved in eight children (29.6%), improved in 14 (51.9%), and was stable in five (18.5%). The overall success rate was 100%. Discussion This study was limited by its small cohort and short follow-up, which may not thoroughly describe the efficacy of the stentless repair as it has been shown that stricture and re-obstruction can occur several years after surgery. Conclusions Robotic stentless Pyeloplasty is a feasible alternative to conventional methods, with excellent success rates and minimal complications. Importantly, this technique circumvents the need for a second procedure and the associated risks of anesthesia. Table . Summary of patient demographics and operative results. Dismembered Bypass Pre-operative variables Patients, n 8 19 Mean age, months (range) 32.6 (44–157) 21.8 (6–122) Male gender, n 6 11 Presumed cause of obstruction Crossing vessel, n 8 0 Intrinsic narrowing, n 0 5 High insertion, n 0 6 Combination (IN + HI) 0 8 Outcome variables Mean follow-up time, months (range) 6.2 (4–18) 8.8 (4–21) Mean length of stay, hours (range) 20.6 (11–46) 20.1 (14–23) 3-month USG results Resolution of hydronephrosis, n 5 3 Improvement of hydronephrosis, n 0 14 No change of hydronephrosis, n 3 2 Worsening of hydronpehrosis, n 0 0 HI, high insertion; IN, intrinsic narrowing; USG, Ultrasound
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robotic Pyeloplasty in the pediatric population
Current Urology Reports, 2009Co-Authors: Pasquale CasaleAbstract:The procedure most performed with the da Vinci system (Intuitive Surgical, Sunnyvale, CA) in pediatric urology is Pyeloplasty for ureteropelvic junction obstruction. As with laparoscopic Pyeloplasty, robotic-assisted Pyeloplasty (RAP) can be performed by a trans- or retroperitoneal approach. Suturing is done with a 6-0 monofilament absorbable suture, but any 5-0 or 6-0 suture can be used depending on the size of the patient. Currently, it appears that nothing larger than 6-0 is recommended for small children and infants. RAP in children has been demonstrated to be feasible and to have satisfactory results. Although there are only a few published series on the long-term outcome to date, the short-term data suggest that outcomes are similar to those of open Pyeloplasty in children, and it appears to be more than promising.
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robot assisted Pyeloplasty in the infant lessons learned
The Journal of Urology, 2006Co-Authors: Alexander Kutikov, Michael Nguyen, Thomas J Guzzo, Daniel Canter, Pasquale CasaleAbstract:Purpose: Robot assisted Pyeloplasty is emerging as an effective tool for treatment of ureteropelvic junction obstruction in the pediatric population. However, access needed for the procedure is difficult in the small abdominal cavity of an infant. We present our experience with infant robot assisted Pyeloplasty, along with some lessons learned that render this procedure possible in these small patients.Materials and Methods: Nine children 3 to 8 months old (mean 5.6) underwent transperitoneal robot assisted Pyeloplasty for ureteropelvic junction obstruction using the da Vinci® Surgical System. All patients underwent Anderson-Hynes dismembered Pyeloplasty without renal pelvis tapering. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography and/or diuretic radionuclide imaging.Results: All infants successfully underwent robot assisted laparoscopic Pyeloplasty without conversion to pure laparoscopy or open procedure. Mean operative time was 122.8 m...
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laparoscopic Pyeloplasty in the infant younger than 6 months is it technically possible
The Journal of Urology, 2006Co-Authors: Alexander Kutikov, Matthew Resnick, Pasquale CasaleAbstract:Purpose: Laparoscopic dismembered Pyeloplasty is an acceptable option for UPJ obstruction in the pediatric population. We report our initial experience with this approach in infants.Materials and Methods: Eight infants 3 to 5 months old (mean 4.5) underwent transperitoneal laparoscopic Pyeloplasty for ureteropelvic junction obstruction. All patients underwent dismembered Pyeloplasty with renal pelvis tapering. Two patients underwent concomitant pyelolithotomy and 1 underwent contralateral nephrectomy. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography and DRI.Results: Mean operative time was 1.8 hours for the Pyeloplasty portion. Mean hospital stay was 1.2 days. The stent was removed 6 weeks postoperatively in all patients except 1. This patient, 1 of the 2 patients who underwent concomitant pyelolithotomy, had development of a new stone while the stent was still indwelling. Laparoscopic Pyeloplasty resulted in 100% resolution of UPJ obstruc...
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comparison of dismembered and nondismembered laparoscopic Pyeloplasty in the pediatric patient
Journal of Endourology, 2004Co-Authors: Pasquale Casale, Byron D Joyner, Ilia S Zeltser, Ernesto T Figueroa, Richard W Grady, Michael E. MitchellAbstract:Background and Purpose: Laparoscopic dismembered Pyeloplasty is an acceptable option for ureteropelvic junction (UPS) obstruction in the pediatric population. We compared our results with dismembered and nondismembered laparoscopic Pyeloplasty. Patients and Methods: A series of 26 children between the ages of 8 months and 15 years (mean age 5 years) underwent transperitoneal laparoscopic Pyeloplasty for an obstruction not caused by a crossing vessel. Nineteen had an Anderson-Hynes dismembered Pyeloplasty (AH), while the remaining seven had a nondismembered Pyeloplasty in a Heineke-Mikulicz fashion (HM). The outcome measures were operative time, length of hospital stay, and resolution of obstruction by ultrasonography and diuretic radionuclide imaging. Results: The mean operative time was 3.1 hours and 2.5 hours for AH and HM, respectively. No difference in hospital stay was noted, with a mean of 3 days. The stent was removed 6 weeks later. Four of the seven patients having nondismembered procedures presen...
Alan B Retik - One of the best experts on this subject based on the ideXlab platform.
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long term experience and outcomes of robotic assisted laparoscopic Pyeloplasty in children and young adults
The Journal of Urology, 2011Co-Authors: Brian J Minnillo, Jose A S Cruz, Rogerio Sayao, Carlo C Passerotti, Constance S Houck, Petra M Meier, Joseph G Borer, David A Diamond, Alan B Retik, Hiep T NguyenAbstract:Purpose: Laparoscopic Pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic Pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time.Materials and Methods: We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic Pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed.Results: Mean operative time and length of hospitalizat...
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parental satisfaction after open versus robot assisted laparoscopic Pyeloplasty results from modified glasgow children s benefit inventory survey
The Journal of Urology, 2010Co-Authors: Drew A Freilich, Caleb P Nelson, Alan B Retik, Frank J Penna, Hiep T NguyenAbstract:Purpose: Since its inception, robot assisted laparoscopic Pyeloplasty has rapidly become the minimally invasive surgical intervention of choice for treating ureteropelvic junction obstruction at our institution. The large initial investment in robot assisted surgery is frequently justified by its association with improved optics and instrument articulation, decreased postoperative pain, shorter length of hospitalization and improved cosmesis. However, there are no data specifically showing patient satisfaction with robot assisted laparoscopic Pyeloplasty compared to traditional open surgery.Materials and Methods: A previously validated satisfaction survey (Glasgow Children's Benefit Inventory) with 14 additional questions specifically addressing postoperative satisfaction was mailed to all parents (as patient proxy) of children who had undergone open or robot assisted laparoscopic Pyeloplasty between January 2006 and December 2008.Results: A total of 78 parents responded (response rate 70%). All responses...
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pediatric laparoscopic dismembered Pyeloplasty
The Journal of Urology, 1995Co-Authors: Craig A Peters, Richard N Schlussel, Alan B RetikAbstract:We performed laparoscopic dismembered Pyeloplasty in a boy with right ureteropelvic junction obstruction using 4 cannula sites, and a dismembering and reanastomosis technique identical to that used in open Pyeloplasty. Interrupted sutures were placed and tied intracorporeally. A nephrostomy tube was placed under direct vision for drainage but no ureteral stent was used. Total operating time was 5 hours. The patient was discharged home 36 hours after the procedure. The nephrostomy tube was removed 10 days postoperatively after radiographic demonstration of patency and 24 hours of clamping without pain. Followup excretory urography at 6 weeks showed much less hydronephrosis and a widely patent anastomosis. Our case illustrates the technical features and feasibility of laparoscopic Pyeloplasty in children, and should encourage further development of pediatric urological reconstructive laparoscopic techniques.
Paul H Noh - One of the best experts on this subject based on the ideXlab platform.
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pediatric standard and robot assisted laparoscopic Pyeloplasty a comparative single institution study
The Journal of Urology, 2013Co-Authors: Edward Riachy, Nicholas G Cost, Robert W Defoor, Pramod P Reddy, Eugene Minevich, Paul H NohAbstract:Purpose: We report our experience and compare the outcomes between standard and robot-assisted laparoscopic Pyeloplasty to treat ureteropelvic junction obstruction in children.Materials and Methods: A retrospective cohort study was performed of all children who underwent standard or robot-assisted laparoscopic Pyeloplasty for ureteropelvic junction obstruction at a single institution from October 2007 to January 2012. Indications for surgery included symptomatic obstruction and abnormal diuretic renal scan. A successful outcome was defined as resolution of clinical symptoms, improvement of hydronephrosis on ultrasound, stable ultrasound with resolution of symptoms or improvement of the drainage curve on diuretic renal scan.Results: We reviewed 18 patients (median age 8.1 years) who underwent standard and 46 (8.8 years) who underwent robot-assisted laparoscopic Pyeloplasty (p = 0.194). Median operative time was 298 minutes (range 145 to 387) for standard and 209 minutes (106 to 540) for robot-assisted lapa...
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transperitoneal laparoscopic Pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children comparison with open surgery
The Journal of Urology, 2007Co-Authors: Lisandro Piaggio, Ernesto T Figueroa, Julia Spencer Barthold, Julie Francguimond, Paul H Noh, Mark Wehry, Ricardo GonzalezAbstract:Purpose: Pediatric laparoscopic Pyeloplasty to treat ureteropelvic junction obstruction has been reported to decrease hospitalization stay and the analgesic requirement compared to open Pyeloplasty. It is not clear if all age groups benefit from this procedure. We compared primary laparoscopic and open Pyeloplasty in infants and children.Materials and Methods: We retrospectively reviewed the records of consecutive primary pyeloplasties at a single institution during a 4.5-year period. Demographic data, body measurements, presentation, indications for surgery, operation type, surgical time, complications, analgesia requirement, hospital stay and outcome were recorded.Results: Patients were divided in the open Pyeloplasty group of 41 and the laparoscopic Pyeloplasty group of 37. The groups were similar with regard to sex and laterality. There were more patients 14 months or younger in the open Pyeloplasty group. Mean surgical time was longer in laparoscopic Pyeloplasty but it decreased significantly after t...
