204 Robotic heminephrectomy in children
Ahmed Barakat1, Tom Cundy2, Naved Alizai1, Azad Najmaldin1
1Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 2Department of Paediatric Surgery, Women’s and Children’s Hospital, Adelaide, Australia


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.