Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible?

Aline Broch; Annabel Paye-Jaouen; Beatrice Bruneau; Mathilde Glenisson; Kiarash Taghavi; Nathalie Botto; Jeanne Goulin; Pauline Lopez; Stefania Querciagrossa; Alaa El Ghoneimi; Souhayl Dahmani; Mary Hidalgo; Thomas Blanc

doi:10.1016/j.euros.2023.03.004

Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible?

Eur Urol Open Sci. 2023 Mar 31:51:55-61. doi: 10.1016/j.euros.2023.03.004. eCollection 2023 May.

Authors

Aline Broch¹, Annabel Paye-Jaouen², Beatrice Bruneau³, Mathilde Glenisson^{1

4}, Kiarash Taghavi^{1

5

6}, Nathalie Botto¹, Jeanne Goulin¹, Pauline Lopez^{2

4}, Stefania Querciagrossa⁷, Alaa El Ghoneimi^{2

4}, Souhayl Dahmani^{3

4}, Mary Hidalgo⁷, Thomas Blanc^{1

4}

Affiliations

¹ Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
² Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert-Debre, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ Department of Paediatric Anaesthesia and Intensive Care, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁴ Université Paris Cité, Paris, France.
⁵ Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Australia.
⁶ Department of Paediatrics, Monash University, Melbourne, Australia.
⁷ Department of Paediatric Anaesthesia and Intensive Care, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.

Abstract

Background: Robot-assisted pyeloplasty is the most frequently performed robotic procedure in children. A retroperitoneal approach limits surgical trauma and avoids peritoneal irritation. This led to the establishment of the criteria for day surgery (DS) and a related clinical care pathway.

Objective: To assess the feasibility and safety of DS in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty (R-RALP).

Design setting and participants: We performed a bicentric prospective study (NCT03274050) over 2 yr involving the two major paediatric urology teaching hospitals in Paris. A clinical pathway and a prospective research protocol were specifically established.

Intervention: DS in selected children undergoing R-RALP.

Outcome measurements and statistical analysis: The primary outcomes were DS failure, 30-d complications, and readmission rates. The secondary outcomes included preoperative characteristics, perioperative parameters, and surgical outcomes. Quantitative variables were expressed as medians with interquartile ranges.

Results and limitations: Thirty-two children fulfilled specific inclusion criteria and were consecutively selected for DS following R-RALP. The median patient age was 7.6 yr (4.1-11.8) and weight 25 kg (14-45). The median console time was 137 min (108-167). There were no intraoperative complications or conversions. Six children were kept under observation overnight and discharged the following day due to persistent pain (n = 3), parental anxiety (n = 2), or a prolonged procedure (n = 1). The median duration of hospital stay of the 26 children in the DS setting was 12.7 h (12.2-13.2). During the 30-d period, there were four emergency room visits (15%) resulting in two patients requiring readmission (8%): one for febrile urinary tract infection (Clavien-Dindo II) and one child with no JJ stent for urinoma (Clavien-Dindo IIIb). Radiological studies confirmed improvement in dilatation for all cases with no recurrence (median follow-up: 15 mo).

Conclusions: This prospective case series is the first to demonstrate the feasibility and safety of DS in children undergoing R-RALP, obviating the need for routine inpatient care. Excellent results can be achieved by careful patient selection, a clear clinical pathway, and a dedicated team. Further evaluation is warranted to assess the cost effectiveness.

Patient summary: This study shows that day surgery after robotic pyeloplasty is both safe and effective in selected children.

Keywords: Ambulatory; Day surgery; Outpatient; Paediatrics; Pyeloplasty; Retroperitoneal; Robot-assisted laparoscopy; Ureteropelvic junction obstruction.