Aim: Hemi-nephroureterectomy, open or laparoscopic, is a technically challenging procedure in infants and children. Robotic assisted surgery may offer clinical and ergonomic advantages over traditional approaches. We report the largest series of robotic assisted trans-peritoneal hemi-nephrectomy with or without total or subtotal ureteric resection.
Methods: All infants and children who required hemi-nephrectomy between July 2007 and March 2017 were included. Indications for surgery were a symptomatic non-functioning moiety. Three robotic ports (optic 8-12mm, instrument 5-8mm) were used in all. In the majority a 3.5-5mm accessary laparoscopic port was also used for a retractor. Haemostasis, renal transection and tissue dissection were achieved using a diathermy scissors and plasmakinetic or ultrasound dissectors. Large blood vessels and distal ureter were secured using a ligature. A suprapubic or urethral catheter was left in-situ for 2-7days. All patients had postoperative follow-up throughout the study period, with ultrasound scan at 1 and 4 months. Further investigations depended on clinical progress and the pre-existing associated conditions. Data was collected prospectively.
Results: There were 34 children (right 22, left 12; upper 30, Lower 4; M/F 11/23; hemi-nephro-total or subtotal ureterectomy 32, hemi-nephrectomy 2). The mean age was 6.7 years, range 1-15. All procedures were successfully completed with minimal blood loss and no conversion or complications. The mean operating time was 156 minutes – total (range 111- 244), 83 – console (range 64-152). The majority required no postoperative opiate analgesia. The median hospital stay was 34hrs (range 20-63). To date one child has developed small cysts at the site of renal transection. There were no other complications.Conclusions: For Robotic hemi-nephroureterectomy our results suggest that intra and post-operative complications are very rare; operating time is similar to other series of open and laparoscopic methods, and the outcome compares favourably.