Abstract
Introduction:
We aim to present the points of the technique of robot-assisted laparoscopic removal of nonfunctional upper pole moiety in children with complete duplicated systems.
Clinical History of the Vignette:
An 8-year-old girl presented to our clinic with continuous urinary incontinence. On physical examination, an ectopic ureteral orifice in the introitus was revealed. The patient's radiologic and functional evaluation indicated a left duplicate system and a left renal upper pole with 5% function.
Intervention:
Based on European Pediatric Urology guidelines, surgery was offered to the family as the recommended course of action. Removal of upper pole moiety was performed by the presented technique. The docking time was 25 minutes and the duration of surgery was 108 minutes.
Patients and Results:
A total of 4 patients (female:male = 3:1) with a mean age of 6.5 years (5–8 years) underwent removal of upper pole moiety for indications including incontinence (n = 3) and recurrent urinary tract infection secondary to vesicoureteral reflux to nonfunctional upper pole (n = 1). All operations were performed with 8-mm ports of the da Vinci XI robotic surgery system by the presented technique. The mean operative time was 136 minutes (90–175 minutes). The mean estimated blood loss was 15 mL (10–20 mL).
Discussion:
In addition to the technique described by Romao et al. for clipping of ectopic ureter in nonfunctioning upper poles, the upper pole artery was clipped and the pelvicaliceal system was excised as much as possible in the presented video. 1 The technique provides a safe traction zone, allows optimal observation of the vasculature to the diseased moiety, and reduces the possibility of damaging the collecting system of the lower pole, which results in prolonged leakage. 2 The vascular structures are not exposed to severe tractions during the dissection of the upper pole retrogradely, and the risk of functional loss is also reduced. 3 –5 In the early postoperative period, no symptoms such as pain or fever was associated with renal parenchymal devascularization. There was no evidence of hydronephrosis in the follow-up, which was found in the previous series.
Conclusion:
Robotic removal of nonfunctional upper pole is a safe surgical treatment for children with duplicated collecting systems.
Patient Consent Statement:
This video publication received written informed consent for publication of the specific patient's case from both parents. Authors have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.
Funding:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
There is no conflict of interest
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Runtime of video: 4 mins 12 secs
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