Minerva Urology and Nephrology最新文献

Background: We present our step-by-step experience regarding the feasibility and surgical setup for a case series of robotic pyeloplasty using the new Hugo^™ RAS System.

Methods: Five consecutives robotic pyeloplasties have been performed, through a trans-peritoneal route. Three robotic ports were placed under direct vision, including an optical 11-mm robotic trocar, and two 8-mm operative robotic ports. Two laparoscopic ports for bed-assistant were placed between robotic ports and below the camera port to avoid clashes. Only three arm carts were used and located behind the back of the patient to leave more working space to the bed-assistant space and avoid internal or external clashes between robotic arms. After docking and paracolic gutter incision, kidney lower pole identification, UPJ stenosis excision, and spatulation of the ureter with double J ureteral catheter placement were key steps of our procedure.

Results: Median Docking and Console time were 4 minutes (IQR: 4-5) and 115 minutes (IQR:105-120), respectively. No intraoperative complications occurred. No additional ports placement was necessary. No robotic instrument clashed, nor clashes between the robotic arms and the bed-assistant were observed. Estimated blood loss was negligible. The patients were discharged on postoperative day 3 after bladder catheter and abdominal drain removal. No complications were recorded within the first 30 postoperative days. Finally, a median follow-up of 4 (IQR: 3-8) reported satisfactory outcomes.

Conclusions: In the setting of robotic pyeloplasty, this novel platform showed a user-friendly docking system, providing satisfactory perioperative outcomes with a simple three-arms configuration.

Background: This paper aimed to compare laparoscopic (LEVUR) vs. robot-assisted (REVUR) Lich Gregoir extravesical ureteral reimplantation (UR) in children with vesicoureteral reflux (VUR).

Methods: The charts of all patients with moderate to high-grade VUR (3 to 5), who received LEVUR or REVUR over a 10-year period (2014-2024), were retrospectively reviewed.

Results: Seventy-six patients (40 girls and 36 boys), with median age of 5.7 years (range 2-11) and moderate to high-grade VUR, were enrolled. VUR was unilateral in 55/76 (72.3%) and bilateral in 21/76 (27.7%). Patients were grouped according to the MIS approach and pathology side. The median operative time (OT) of unilateral non-dismembered UR was similar in LEVUR (65 min) and REVUR (50 min) (P=0.56). REVUR was faster than LEVUR in unilateral dismembered (90 vs. 120 min) (P=0.001) and bilateral UR (105 vs. 160 min) (P=0.001). The radiographic VUR resolution rate was similar between REVUR and LEVUR (97.8% vs. 96.7%) (P=0.89). Two patients (2.6%) reported low-grade persistent reflux without need for additional treatments. Mild bladder dysfunction developed in 2/21 (9.5%) undergoing bilateral UR (Clavien-Dindo 2).

Conclusions: REVUR is technically easier, faster and provides better ergonomics compared to LEVUR. The postoperative outcomes are excellent in both techniques, with success rates higher than 95%. Complications developed after bilateral reimplantation in patients who had previous history of bladder dysfunction. Given the robot availability, we believe that the best indication for LEVUR remains unilateral reflux without need for ureteral tapering. In unilateral refluxing megaureter, para-ureteral diverticulum or bilateral cases, REVUR represents the best choice.