The Robot-Assisted Extravesical Anti-reflux Surgery: How We Overcame the Learning Curve

Frontiers in Pediatrics

article

Ravindra Sahadev¹  Katelyn Spencer¹  Arun K. Srinivasan¹  Christopher J. Long¹  Aseem Ravindra Shukla¹ 

[1] Division of Pediatric Urology, Children's Hospital of Philadelphia, United States

关键词: robotic;    ureteral reimplantation;    RALUR;    learning curve;    extravesical approach;   

DOI  :  10.3389/fped.2019.00093

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY