Modified robotic-assisted laparoscopic pyeloplasty in children for ureteropelvic junction obstruction with long proximal ureteral stricture: The "double-flap" technique

Ce Han; Lifei Ma; Pin Li; Jia'nan Wang; Xiaoguang Zhou; Tian Tao; Hualin Cao; Yuandong Tao; Yunjie Yang; Yang Zhao; Weiwei Zhu; Tao Guo; Xuexue Lyu; Ran Zhuo; Huixia Zhou

doi:10.3389/fped.2022.964147

Modified robotic-assisted laparoscopic pyeloplasty in children for ureteropelvic junction obstruction with long proximal ureteral stricture: The "double-flap" technique

Front Pediatr. 2022 Oct 14:10:964147. doi: 10.3389/fped.2022.964147. eCollection 2022.

Authors

Ce Han^{1

2

3}, Lifei Ma^{1

2}, Pin Li^{1

2}, Jia'nan Wang⁴, Xiaoguang Zhou^{1

2}, Tian Tao^{1

2}, Hualin Cao⁵, Yuandong Tao^{1

2}, Yunjie Yang⁶, Yang Zhao^{1

2}, Weiwei Zhu^{1

2

3}, Tao Guo^{1

2

3}, Xuexue Lyu^{1

2

3}, Ran Zhuo^{1

2}, Huixia Zhou^{1

2}

Affiliations

¹ Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.
² Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China.
³ Medical School of Chinese PLA, Beijing, China.
⁴ Surgical Intensive Care Unit, The Second Medical Center of PLA General Hospital, Beijing, China.
⁵ Department of Urology, Nanxi Shan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China.
⁶ Department of Urology, Southern Medical University Affiliated Nanhai Hospital, Foshan, China.

Abstract

Objective: The objective of this study is to introduce a novel technique of robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) with long proximal ureteral stricture in children.

Materials and methods: Clinical information on patients who underwent a modified RALP between July 2018 and May 2019 in our center was collected retrospectively. Our surgical modifications mainly include "double-flap" tailoring of the renal pelvis and anastomosis of spatulate ureter with the double-flap. Demographic, perioperative, postoperative, and follow-up information was recorded in detail.

Results: A total of 13 patients were included in the study. All the patients underwent a modified RALP without conversion to open surgery. They were followed up with a median time of 36 months. The anteroposterior diameter of the renal pelvis was 1.19 ± 0.21 at 6 months after the surgery, which was significantly lower than that on admission (3.93 ± 0.79). The split renal function of the children was also significantly improved from 0.37 ± 0.05) to 0.46 ± 0.02 at 6 months after surgery (p < 0.05). The diuretic renography revealed that all the patients have a T1/2 time less than 20 min postoperatively. The children were in good condition during the follow-up period.

Conclusions: Modified RALP is an effective surgical treatment for children with UPJO with long proximal ureteral stricture. The success rate of this modification has been preliminarily confirmed.

Keywords: hydronephrosis; long proximal ureteral stricture; modified robotic-assisted laparoscopic pyeloplasty (MRALP); pediatrics; renal pelvic flaps.