ArticleJournal of robotic surgery2025
Facing the toughest cases: the role of robot-assisted laparoscopic ureteral reimplantation (RALUR) in pediatric urology - a multicenter analysis.
Article in Journal of robotic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Even though robotic surgery is well described in simple vesico-ureteral reflux (VUR), few studies explore its role in complex uretero-vesical junction (UVJ) anomalies or redo surgery. This study assesses the role of different robotic surgical procedures and clinical features that can impact the result of complex robotic ureteral reimplantation in children. Retrospective, multicenter cohort of pediatric patients who underwent robotic reimplantation between 2017 and 2023 in case of redo surgery or complex UVJ anatomy. Reimplantation techniques included: dismembered and non-dismembered Lich-Gregoire(D-RALUR, ND-RALUR), Dismembered Extravesical Cross-Trigonal reimplantation(RADECUR). Major criteria of resolution: no symptoms and/or reintervention with a minimum follow-up of 6 months. The study included 6 centers, 134 patients, median age 4 years (IQR 2.1-6.6; range: 0.5-17.4), median weight 15.2 Kg(IQR 13.1-22.0; range: 6.7-80.0). Redo surgery(48, 35.8%), duplex systems(38, 28.4%), obstructive megaureter(29, 21.6%) and others(27, 20.1%). D-RALUR 65 (48.5%), ND-RALUR 56(41.8%), RADECUR 13(9.7%). Early post-operative complication rate was 17.9%(including Clavien I-IIIb, with major complications, grade IIIb in 4.5% of patients - 2 incisional hernia, 4 UVJ stenosis). At a median follow-up of 21.2 months (IQR 11.7-33.3; range 6.0-80.1) the resolution was 82.2%. The comparative analysis found no significant difference in resolution respect to pathology (p = 0.179), technique (p = 0.331), age (p = 0.937) and weight (p = 0-495). There was no statistical difference in resolution rate when stratifying on weight ≤ 10Kg (p = 0.633) and ≤ 15 kg (p = 0.586). Within patients who experienced treatment failure we recorded 9 UVJ obstruction: 5(9%)D-RALUR, 4(8%)ND-RALUR; 11 VUR: 2(15%)RADECUR, 7(12%) D-RALUR, 2 (4%)ND-RALUR and 1 recurrent febrile UTI without VUR or obstruction: 1(D-RALUR). Robotic reimplantation is a valid option in case of complex pediatric UVJ pathologies, with good results also in children with a < 10 kg body weight.
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