The Robot-Assisted Extravesical Anti-reflux Surgery: How We Overcame the Learning Curve
Management of vesicoureteral reflux (VUR) has evolved over the past several decades, with a trend toward a decrease in surgical management. In spite of this, ureteral reimplantation remains a commonly performed procedure by pediatric urologists in selected cases. Although the basic tenets of the ure...
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| Published in | Frontiers in pediatrics Vol. 7; p. 93 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
Frontiers Media S.A
29.03.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2296-2360 2296-2360 |
| DOI | 10.3389/fped.2019.00093 |
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| Abstract | Management of vesicoureteral reflux (VUR) has evolved over the past several decades, with a trend toward a decrease in surgical management. In spite of this, ureteral reimplantation remains a commonly performed procedure by pediatric urologists in selected cases. Although the basic tenets of the ureteral reimplant procedure remain the same, the extra- vs. intravesical approach, and the traditional open vs. minimally invasive approach remain the primary options to correct reflux. Considering the advantages conferred by the robotic surgery platform, many leading centers have preferentially adopted robot-assisted laparoscopic extravesical anti-reflux surgery, or in common surgical parlance, the robot-assisted laparoscopic ureteral reimplantation (RALUR), over pure laparoscopic or open approaches. Predicated on our experience of performing over 170 cases of RALUR, we have made technical modifications which we posit reduce the morbidity of the procedure while offering acceptable outcomes. This review highlights the evolution and establishment of RALUR as a standardization of care in the surgical management of VUR at our institution. In particular, we emphasize the technical nuances and specific challenges encountered through the learning curve in hopes of facilitating this process for others. |
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| AbstractList | Management of vesicoureteral reflux (VUR) has evolved over the past several decades, with a trend toward a decrease in surgical management. In spite of this, ureteral reimplantation remains a commonly performed procedure by pediatric urologists in selected cases. Although the basic tenets of the ureteral reimplant procedure remain the same, the extra- vs. intravesical approach, and the traditional open vs. minimally invasive approach remain the primary options to correct reflux. Considering the advantages conferred by the robotic surgery platform, many leading centers have preferentially adopted robot-assisted laparoscopic extravesical anti-reflux surgery, or in common surgical parlance, the robot-assisted laparoscopic ureteral reimplantation (RALUR), over pure laparoscopic or open approaches. Predicated on our experience of performing over 170 cases of RALUR, we have made technical modifications which we posit reduce the morbidity of the procedure while offering acceptable outcomes. This review highlights the evolution and establishment of RALUR as a standardization of care in the surgical management of VUR at our institution. In particular, we emphasize the technical nuances and specific challenges encountered through the learning curve in hopes of facilitating this process for others. Management of vesicoureteral reflux (VUR) has evolved over the past several decades, with a trend toward a decrease in surgical management. In spite of this, ureteral reimplantation remains a commonly performed procedure by pediatric urologists in selected cases. Although the basic tenets of the ureteral reimplant procedure remain the same, the extra- vs. intravesical approach, and the traditional open vs. minimally invasive approach remain the primary options to correct reflux. Considering the advantages conferred by the robotic surgery platform, many leading centers have preferentially adopted robot-assisted laparoscopic extravesical anti-reflux surgery, or in common surgical parlance, the robot-assisted laparoscopic ureteral reimplantation (RALUR), over pure laparoscopic or open approaches. Predicated on our experience of performing over 170 cases of RALUR, we have made technical modifications which we posit reduce the morbidity of the procedure while offering acceptable outcomes. This review highlights the evolution and establishment of RALUR as a standardization of care in the surgical management of VUR at our institution. In particular, we emphasize the technical nuances and specific challenges encountered through the learning curve in hopes of facilitating this process for others.Management of vesicoureteral reflux (VUR) has evolved over the past several decades, with a trend toward a decrease in surgical management. In spite of this, ureteral reimplantation remains a commonly performed procedure by pediatric urologists in selected cases. Although the basic tenets of the ureteral reimplant procedure remain the same, the extra- vs. intravesical approach, and the traditional open vs. minimally invasive approach remain the primary options to correct reflux. Considering the advantages conferred by the robotic surgery platform, many leading centers have preferentially adopted robot-assisted laparoscopic extravesical anti-reflux surgery, or in common surgical parlance, the robot-assisted laparoscopic ureteral reimplantation (RALUR), over pure laparoscopic or open approaches. Predicated on our experience of performing over 170 cases of RALUR, we have made technical modifications which we posit reduce the morbidity of the procedure while offering acceptable outcomes. This review highlights the evolution and establishment of RALUR as a standardization of care in the surgical management of VUR at our institution. In particular, we emphasize the technical nuances and specific challenges encountered through the learning curve in hopes of facilitating this process for others. |
| Author | Spencer, Katelyn Shukla, Aseem Ravindra Srinivasan, Arun K. Sahadev, Ravindra Long, Christopher J. |
| AuthorAffiliation | Division of Pediatric Urology, Children's Hospital of Philadelphia , Philadelphia, PA , United States |
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| Cites_doi | 10.1089/end.2008.0320 10.1089/end.2014.0815 10.1016/S0022-5347(17)65934-2 10.1016/j.jpurol.2015.11.007 10.1016/j.juro.2010.12.069 10.1007/s11701-011-0288-1 10.1016/j.jpurol.2017.01.021 10.1016/j.urology.2016.07.024 10.1016/j.jpurol.2014.02.013 10.1016/j.jpurol.2011.04.006 10.1016/j.juro.2008.01.062 10.1111/iju.12483 10.1016/j.jpurol.2014.01.028 10.1016/j.juro.2014.07.128 10.1111/bju.12813 10.1016/j.ucl.2004.06.007 10.4111/icu.2017.58.1.3 10.1155/2008/815472 10.1016/j.jpurol.2016.05.042 10.1016/j.eururo.2012.01.002 10.1016/j.juro.2017.03.112 10.1016/j.eururo.2016.02.065 10.1016/j.juro.2017.01.062 10.3389/fped.2017.00175 10.1016/j.juro.2010.12.072 10.1016/j.jpurol.2018.02.018 10.1016/j.urology.2011.10.052 10.1007/s11934-006-0071-4 10.1016/j.jpurol.2018.01.020 10.1089/end.2005.19.618 |
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| Copyright | Copyright © 2019 Sahadev, Spencer, Srinivasan, Long and Shukla. 2019 Sahadev, Spencer, Srinivasan, Long and Shukla |
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| References | Peters (B10) 2005; 19 Casale (B13) 2008; 179 Boysen (B7) 2017; 197 Chan (B12) 2012; 6 Schomburg (B14) 2014; 10 Arlen (B26) 2016; 12 Akhavan (B18) 2014; 10 Hayashi (B25) 2014; 21 Kasturi (B22) 2012; 79 Srinivasan (B15) 2017; 13 Baek (B30) 2017; 58 Cannon (B5) 2017; 197 Paquin (B4) 1959; 82 Sillén (B16) 2008; 8 Smith (B17) 2011; 185 Kaul (B29) 2016; 7 Marchini (B11) 2011; 185 Herz (B27) 2016; 12 Chalmers (B19) 2012; 8 Qureshi (B2) 2017; 5 Boysen (B8) 2018; 14 Gargollo (B6) 2018; 14 Peters (B9) 2004; 31 Gundeti (B20) 2016; 70 Kurtz (B3) 2017; 100 Pruthi (B28) 2008; 22 Silay (B21) 2015; 29 Grimsby (B24) 2015 Dangle (B23) 2014; 114 Routh (B1) 2012; 61 |
| References_xml | – volume: 22 start-page: 2469 year: 2008 ident: B28 article-title: Evaluating the learning curve for robot-assisted laparoscopic radical cystectomy publication-title: J Endourol. doi: 10.1089/end.2008.0320 – volume: 29 start-page: 864 year: 2015 ident: B21 article-title: Robot-assisted laparoscopic extravesical ureteral reimplantation in children: top-down suturing technique without stent placement publication-title: J Endourol. doi: 10.1089/end.2014.0815 – volume: 82 start-page: 573 year: 1959 ident: B4 article-title: Ureterovesical anastomosis: the description and evaluation of a technique publication-title: J Urol. doi: 10.1016/S0022-5347(17)65934-2 – volume: 12 start-page: 169.e1 year: 2016 ident: B26 article-title: Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population publication-title: J Pediatr Urol. doi: 10.1016/j.jpurol.2015.11.007 – volume: 185 start-page: 1870 year: 2011 ident: B11 article-title: Robotic assisted laparoscopic ureteral reimplantation in children: case matched comparative study with open surgical approach publication-title: J Urol. doi: 10.1016/j.juro.2010.12.069 – volume: 6 start-page: 259 year: 2012 ident: B12 article-title: Early experience in robotic-assisted laparoscopic bilateral intravesical ureteral reimplantation for vesicoureteral reflux in children publication-title: J Robot Surg. doi: 10.1007/s11701-011-0288-1 – volume: 13 start-page: 494.e1 year: 2017 ident: B15 article-title: Is robot-assisted laparoscopic bilateral extravesical ureteral reimplantation associated with greater morbidity than unilateral surgery? publication-title: J Pediatr Urol. doi: 10.1016/j.jpurol.2017.01.021 – volume: 100 start-page: 193 year: 2017 ident: B3 article-title: The decline of the open ureteral reimplant in the United States: National data from 2003 to 2013 publication-title: Urology. doi: 10.1016/j.urology.2016.07.024 – volume: 10 start-page: 875 year: 2014 ident: B14 article-title: Robot-assisted laparoscopic ureteral reimplantation: a single surgeon comparison to open surgery publication-title: J Pediatr Urol. doi: 10.1016/j.jpurol.2014.02.013 – volume: 8 start-page: 268 year: 2012 ident: B19 article-title: Robotic-assisted laparoscopic extravesical ureteral reimplantation: an initial experience publication-title: J Pediatr Urol. doi: 10.1016/j.jpurol.2011.04.006 – volume: 179 start-page: 1987 year: 2008 ident: B13 article-title: Nerve sparing robotic extravesical ureteral reimplantation publication-title: J Urol doi: 10.1016/j.juro.2008.01.062 – volume: 21 start-page: 1016 year: 2014 ident: B25 article-title: Extravesical robot-assisted laparoscopic ureteral reimplantation for vesicoureteral reflux: initial experience in Japan with the ureteral advancement technique publication-title: Int J Urol. doi: 10.1111/iju.12483 – volume: 10 start-page: 864 year: 2014 ident: B18 article-title: Robot-assisted extravesical ureteral reimplantation: outcomes and conclusions from 78 ureters publication-title: J Pediatr Urol. doi: 10.1016/j.jpurol.2014.01.028 – year: 2015 ident: B24 article-title: Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation publication-title: J Urol. doi: 10.1016/j.juro.2014.07.128 – volume: 114 start-page: 630 year: 2014 ident: B23 article-title: Robot-assisted laparoscopic ureteric reimplantation: extravesical technique publication-title: BJU Int. doi: 10.1111/bju.12813 – volume: 31 start-page: 743 year: 2004 ident: B9 article-title: Robotically assisted surgery in pediatric urology publication-title: Urol Clin North Am. doi: 10.1016/j.ucl.2004.06.007 – volume: 58 start-page: 3 year: 2017 ident: B30 article-title: Lessons learned over a decade of pediatric robotic ureteral reimplantation publication-title: Investig Clin Urol doi: 10.4111/icu.2017.58.1.3 – volume: 8 start-page: 815472 year: 2008 ident: B16 article-title: Bladder dysfunction and vesicoureteral reflux publication-title: Adv Urol. doi: 10.1155/2008/815472 – volume: 12 start-page: 402.e1 year: 2016 ident: B27 article-title: Robot-assisted laparoscopic extravesical ureteral reimplant: A critical look at surgical outcomes publication-title: J Pediatr Urol doi: 10.1016/j.jpurol.2016.05.042 – volume: 61 start-page: 773e82 year: 2012 ident: B1 article-title: Vesicoureteral reflux: current trends in diagnosis, screening, and treatment publication-title: Eur Urol. doi: 10.1016/j.eururo.2012.01.002 – volume: 197 start-page: 1379 year: 2017 ident: B5 article-title: Robot-assisted laparoscopic extravesical ureteral reimplantation for primary vesicoureteral reflux in children publication-title: J Urol. doi: 10.1016/j.juro.2017.03.112 – volume: 70 start-page: 818 year: 2016 ident: B20 article-title: Robot-assisted laparoscopic extravesical ureteral reimplantation: technique modifications contribute to optimized outcomes publication-title: Eur Urol. doi: 10.1016/j.eururo.2016.02.065 – volume: 197 start-page: 1555 year: 2017 ident: B7 article-title: Multi-institutional review of outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for treatment of primary vesicoureteral reflux in children publication-title: J Urol. doi: 10.1016/j.juro.2017.01.062 – volume: 5 start-page: 175 year: 2017 ident: B2 article-title: Decreased Identification of vesicoureteral reflux: a cautionary tale publication-title: Front Pediatr. doi: 10.3389/fped.2017.00175 – volume: 185 start-page: 1876 year: 2011 ident: B17 article-title: Pediatric robotic extravesical ureteral reimplantation: comparison with open surgery publication-title: J Urol. doi: 10.1016/j.juro.2010.12.072 – volume: 14 start-page: 263 year: 2018 ident: B6 article-title: Editorial comment regarding: Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): outcomes and complications publication-title: J Ped Urol. doi: 10.1016/j.jpurol.2018.02.018 – volume: 79 start-page: 680 year: 2012 ident: B22 article-title: Prospective long-term analysis of nerve-sparing extravesical robotic-assisted laparoscopic ureteral reimplantation publication-title: Urology. doi: 10.1016/j.urology.2011.10.052 – volume: 7 start-page: 125 year: 2016 ident: B29 article-title: Learning curve using robotic surgery publication-title: Curr Urol Reports doi: 10.1007/s11934-006-0071-4 – volume: 14 start-page: 262.e1 year: 2018 ident: B8 article-title: Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications publication-title: J Pediatr Urol. doi: 10.1016/j.jpurol.2018.01.020 – volume: 19 start-page: 618 year: 2005 ident: B10 article-title: Intravesical robotically assisted bilateral ureteral reimplantation publication-title: J Endourol. doi: 10.1089/end.2005.19.618 |
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| Title | The Robot-Assisted Extravesical Anti-reflux Surgery: How We Overcame the Learning Curve |
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