Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study

P. P. Dangle, A. Akhavan, M. Odeleye, D. Avery, T. Lendvay, C. J. Koh, J. S. Elder, P. H. Noh, D. Bansal, M. Schulte, J. MacDonald, A. Shukla, C. Kim, K. Herbst, S. Corbett, J. Kearns, R. Kunnavakkam, M. S. Gundeti

Research output: Contribution to journalArticle

Abstract

Background: Robotic technology is the newest tool in the armamentarium for minimally invasive surgery. Individual centers have reported on both the outcomes and complications associated with this technology, but the numbers in these studies remain small, and it has been difficult to extrapolate meaningful information. Objectives: The intention was to evaluate a large cohort of pediatric robotic patients through a multi-center database in order to determine the frequency and types of complications associated with robotic surgery for pediatric reconstructive and ablative procedures in the United States. Study design: After institutional review board approvals at the participating centers, data were retrospectively collected (2007-2011) by each institute and entered into a RedCap® database. Available demographic and complication data that were assigned Clavien grading scores were analyzed. Results: From a cohort of 858 patients (880 RAL procedures), Grade IIIa and Grade IIIb complications were seen in 41 (4.8%); and one patient (0.1%) had a grade IVa complication. Intraoperative visceral injuries secondary to robotic instrument exchange and traction injury were seen in four (0.5%) patients, with subsequent conversion to an open procedure. Grade I and II complications were seen in 59 (6.9%) and 70 (8.2%) patients, respectively; they were all managed conservatively. A total of 14 (1.6%) were converted to an open or pure laparoscopic procedure, of which, 12 (86%) were secondary to mechanical challenges. Discussion: It is believed that this study represents the largest and most comprehensive description of pediatric RAL urological complications to date. The results demonstrate a 4.7% rate of Clavien Grade IIIa and Grade IIIb complications in a total of 880 cases. While small numbers make it difficult to draw conclusions regarding the most complex reconstructive cases (bladder diverticulectomy, bladder neck revision, etc.), the data on the more commonly performed procedures, such as the RAL pyeloplasty and ureteral reimplantation, are robust and more likely represent the true complication rate for these procedures when performed by highly experienced robotic surgeons. Conclusion: Pediatric robotic urologic procedures are technically feasible and safe. The overall 90-day complication rate is similar to reports of laparoscopic and open surgical procedures.Complications: n (%). Life threatening (IVa): 1 (0.1%). Requiring radiologic and or surgical intervention (IIIa and IIIb): 41 (4.8%). Secondary to robotic system: 4 (0.5%). Mechanical failure leading to conversion: 14 (1.6%).

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StateAccepted/In press - Mar 31 2015

Fingerprint

Robotics
Pediatrics
Reconstructive Surgical Procedures
Urinary Bladder
Databases
Conversion to Open Surgery
Technology
Minimally Invasive Surgical Procedures
Replantation
Research Ethics Committees
Wounds and Injuries
Traction
Laparoscopy
Demography

Keywords

  • Clavien-Dindo grading system
  • Complication
  • Multi-institutional
  • Pediatric
  • Robotic

ASJC Scopus subject areas

  • Urology
  • Pediatrics, Perinatology, and Child Health

Cite this

Dangle, P. P., Akhavan, A., Odeleye, M., Avery, D., Lendvay, T., Koh, C. J., ... Gundeti, M. S. (Accepted/In press). Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study. Journal of Pediatric Urology. https://doi.org/10.1016/j.jpurol.2015.08.015

Ninety-day perioperative complications of pediatric robotic urological surgery : A multi-institutional study. / Dangle, P. P.; Akhavan, A.; Odeleye, M.; Avery, D.; Lendvay, T.; Koh, C. J.; Elder, J. S.; Noh, P. H.; Bansal, D.; Schulte, M.; MacDonald, J.; Shukla, A.; Kim, C.; Herbst, K.; Corbett, S.; Kearns, J.; Kunnavakkam, R.; Gundeti, M. S.

In: Journal of Pediatric Urology, 31.03.2015.

Research output: Contribution to journalArticle

Dangle, PP, Akhavan, A, Odeleye, M, Avery, D, Lendvay, T, Koh, CJ, Elder, JS, Noh, PH, Bansal, D, Schulte, M, MacDonald, J, Shukla, A, Kim, C, Herbst, K, Corbett, S, Kearns, J, Kunnavakkam, R & Gundeti, MS 2015, 'Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study', Journal of Pediatric Urology. https://doi.org/10.1016/j.jpurol.2015.08.015
Dangle, P. P. ; Akhavan, A. ; Odeleye, M. ; Avery, D. ; Lendvay, T. ; Koh, C. J. ; Elder, J. S. ; Noh, P. H. ; Bansal, D. ; Schulte, M. ; MacDonald, J. ; Shukla, A. ; Kim, C. ; Herbst, K. ; Corbett, S. ; Kearns, J. ; Kunnavakkam, R. ; Gundeti, M. S. / Ninety-day perioperative complications of pediatric robotic urological surgery : A multi-institutional study. In: Journal of Pediatric Urology. 2015.
@article{16e2df9e9598475cbc2afb766b0f5760,
title = "Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study",
abstract = "Background: Robotic technology is the newest tool in the armamentarium for minimally invasive surgery. Individual centers have reported on both the outcomes and complications associated with this technology, but the numbers in these studies remain small, and it has been difficult to extrapolate meaningful information. Objectives: The intention was to evaluate a large cohort of pediatric robotic patients through a multi-center database in order to determine the frequency and types of complications associated with robotic surgery for pediatric reconstructive and ablative procedures in the United States. Study design: After institutional review board approvals at the participating centers, data were retrospectively collected (2007-2011) by each institute and entered into a RedCap{\circledR} database. Available demographic and complication data that were assigned Clavien grading scores were analyzed. Results: From a cohort of 858 patients (880 RAL procedures), Grade IIIa and Grade IIIb complications were seen in 41 (4.8{\%}); and one patient (0.1{\%}) had a grade IVa complication. Intraoperative visceral injuries secondary to robotic instrument exchange and traction injury were seen in four (0.5{\%}) patients, with subsequent conversion to an open procedure. Grade I and II complications were seen in 59 (6.9{\%}) and 70 (8.2{\%}) patients, respectively; they were all managed conservatively. A total of 14 (1.6{\%}) were converted to an open or pure laparoscopic procedure, of which, 12 (86{\%}) were secondary to mechanical challenges. Discussion: It is believed that this study represents the largest and most comprehensive description of pediatric RAL urological complications to date. The results demonstrate a 4.7{\%} rate of Clavien Grade IIIa and Grade IIIb complications in a total of 880 cases. While small numbers make it difficult to draw conclusions regarding the most complex reconstructive cases (bladder diverticulectomy, bladder neck revision, etc.), the data on the more commonly performed procedures, such as the RAL pyeloplasty and ureteral reimplantation, are robust and more likely represent the true complication rate for these procedures when performed by highly experienced robotic surgeons. Conclusion: Pediatric robotic urologic procedures are technically feasible and safe. The overall 90-day complication rate is similar to reports of laparoscopic and open surgical procedures.Complications: n ({\%}). Life threatening (IVa): 1 (0.1{\%}). Requiring radiologic and or surgical intervention (IIIa and IIIb): 41 (4.8{\%}). Secondary to robotic system: 4 (0.5{\%}). Mechanical failure leading to conversion: 14 (1.6{\%}).",
keywords = "Clavien-Dindo grading system, Complication, Multi-institutional, Pediatric, Robotic",
author = "Dangle, {P. P.} and A. Akhavan and M. Odeleye and D. Avery and T. Lendvay and Koh, {C. J.} and Elder, {J. S.} and Noh, {P. H.} and D. Bansal and M. Schulte and J. MacDonald and A. Shukla and C. Kim and K. Herbst and S. Corbett and J. Kearns and R. Kunnavakkam and Gundeti, {M. S.}",
year = "2015",
month = "3",
day = "31",
doi = "10.1016/j.jpurol.2015.08.015",
language = "English (US)",
journal = "Journal of Pediatric Urology",
issn = "1477-5131",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Ninety-day perioperative complications of pediatric robotic urological surgery

T2 - A multi-institutional study

AU - Dangle, P. P.

AU - Akhavan, A.

AU - Odeleye, M.

AU - Avery, D.

AU - Lendvay, T.

AU - Koh, C. J.

AU - Elder, J. S.

AU - Noh, P. H.

AU - Bansal, D.

AU - Schulte, M.

AU - MacDonald, J.

AU - Shukla, A.

AU - Kim, C.

AU - Herbst, K.

AU - Corbett, S.

AU - Kearns, J.

AU - Kunnavakkam, R.

AU - Gundeti, M. S.

PY - 2015/3/31

Y1 - 2015/3/31

N2 - Background: Robotic technology is the newest tool in the armamentarium for minimally invasive surgery. Individual centers have reported on both the outcomes and complications associated with this technology, but the numbers in these studies remain small, and it has been difficult to extrapolate meaningful information. Objectives: The intention was to evaluate a large cohort of pediatric robotic patients through a multi-center database in order to determine the frequency and types of complications associated with robotic surgery for pediatric reconstructive and ablative procedures in the United States. Study design: After institutional review board approvals at the participating centers, data were retrospectively collected (2007-2011) by each institute and entered into a RedCap® database. Available demographic and complication data that were assigned Clavien grading scores were analyzed. Results: From a cohort of 858 patients (880 RAL procedures), Grade IIIa and Grade IIIb complications were seen in 41 (4.8%); and one patient (0.1%) had a grade IVa complication. Intraoperative visceral injuries secondary to robotic instrument exchange and traction injury were seen in four (0.5%) patients, with subsequent conversion to an open procedure. Grade I and II complications were seen in 59 (6.9%) and 70 (8.2%) patients, respectively; they were all managed conservatively. A total of 14 (1.6%) were converted to an open or pure laparoscopic procedure, of which, 12 (86%) were secondary to mechanical challenges. Discussion: It is believed that this study represents the largest and most comprehensive description of pediatric RAL urological complications to date. The results demonstrate a 4.7% rate of Clavien Grade IIIa and Grade IIIb complications in a total of 880 cases. While small numbers make it difficult to draw conclusions regarding the most complex reconstructive cases (bladder diverticulectomy, bladder neck revision, etc.), the data on the more commonly performed procedures, such as the RAL pyeloplasty and ureteral reimplantation, are robust and more likely represent the true complication rate for these procedures when performed by highly experienced robotic surgeons. Conclusion: Pediatric robotic urologic procedures are technically feasible and safe. The overall 90-day complication rate is similar to reports of laparoscopic and open surgical procedures.Complications: n (%). Life threatening (IVa): 1 (0.1%). Requiring radiologic and or surgical intervention (IIIa and IIIb): 41 (4.8%). Secondary to robotic system: 4 (0.5%). Mechanical failure leading to conversion: 14 (1.6%).

AB - Background: Robotic technology is the newest tool in the armamentarium for minimally invasive surgery. Individual centers have reported on both the outcomes and complications associated with this technology, but the numbers in these studies remain small, and it has been difficult to extrapolate meaningful information. Objectives: The intention was to evaluate a large cohort of pediatric robotic patients through a multi-center database in order to determine the frequency and types of complications associated with robotic surgery for pediatric reconstructive and ablative procedures in the United States. Study design: After institutional review board approvals at the participating centers, data were retrospectively collected (2007-2011) by each institute and entered into a RedCap® database. Available demographic and complication data that were assigned Clavien grading scores were analyzed. Results: From a cohort of 858 patients (880 RAL procedures), Grade IIIa and Grade IIIb complications were seen in 41 (4.8%); and one patient (0.1%) had a grade IVa complication. Intraoperative visceral injuries secondary to robotic instrument exchange and traction injury were seen in four (0.5%) patients, with subsequent conversion to an open procedure. Grade I and II complications were seen in 59 (6.9%) and 70 (8.2%) patients, respectively; they were all managed conservatively. A total of 14 (1.6%) were converted to an open or pure laparoscopic procedure, of which, 12 (86%) were secondary to mechanical challenges. Discussion: It is believed that this study represents the largest and most comprehensive description of pediatric RAL urological complications to date. The results demonstrate a 4.7% rate of Clavien Grade IIIa and Grade IIIb complications in a total of 880 cases. While small numbers make it difficult to draw conclusions regarding the most complex reconstructive cases (bladder diverticulectomy, bladder neck revision, etc.), the data on the more commonly performed procedures, such as the RAL pyeloplasty and ureteral reimplantation, are robust and more likely represent the true complication rate for these procedures when performed by highly experienced robotic surgeons. Conclusion: Pediatric robotic urologic procedures are technically feasible and safe. The overall 90-day complication rate is similar to reports of laparoscopic and open surgical procedures.Complications: n (%). Life threatening (IVa): 1 (0.1%). Requiring radiologic and or surgical intervention (IIIa and IIIb): 41 (4.8%). Secondary to robotic system: 4 (0.5%). Mechanical failure leading to conversion: 14 (1.6%).

KW - Clavien-Dindo grading system

KW - Complication

KW - Multi-institutional

KW - Pediatric

KW - Robotic

UR - http://www.scopus.com/inward/record.url?scp=84958581784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958581784&partnerID=8YFLogxK

U2 - 10.1016/j.jpurol.2015.08.015

DO - 10.1016/j.jpurol.2015.08.015

M3 - Article

C2 - 26897324

AN - SCOPUS:84958581784

JO - Journal of Pediatric Urology

JF - Journal of Pediatric Urology

SN - 1477-5131

ER -