INTRODUCTION AND OBJECTIVES: Open ureteral reimplantation (OR) is the gold standard for surgical treatment of vesicoureteral reflux. Although robot assisted laparoscopic ureteral reimplantation (RALR) is less invasive, there has been no study comparing the effectiveness of RALR with OR.

METHODS: We performed a retrospective chart review of OR and RALR performed from June 2006 to October 2009. One surgeon performed only intravesical OR from June 2006 to October 2009 (group 1, n=94), while second surgeon performed only extravesical RALR from August 2008 to October 2009 (group 2, n=84). This created two comparable and consecutive study groups of patients. Age, gender, weight, grade of reflux, indication for surgery, type of surgery, surgical time, blood loss, postoperative narcotic use, hospital stay, complications and outcomes were recorded. Data was compared between the two groups for statistical significance.

RESULTS: Weight, age, sex, indication for surgery, and grade of reflux were similar in both groups. The mean weight was 18.2 kg in group 1 and 21.1 kg in group 2, while the mean age was 51.6 months and 64.8 months, respectively. While the mean surgical time was longer in group 2 at 121 min. versus 83 min. (p<.0001), the mean hospital stay was shorter at 1.1 days versus 2.1 days (p<.0001). Postoperative narcotic use was the same, however, all the patients in group 1 received caudal injections while none in group 2 received caudal injections. Postoperative complications were similar in both groups, 3/94 in group 1 versus 5/84 in group 2 (NS). Long term follow up reveals similar results in rates of postoperative febrile UTI's in both groups, 3/94 in group 1 versus 2/84 in group 2 (NS).

CONCLUSIONS: Robot assisted laparoscopic ureteral reimplantations can be performed safely and effectively in infants and children. Postoperative complications and recurrence of febrile UTI's are similar in both groups. Longer mean operating time is noted in group 2, however, shorter hospital stay offer benefits to patients and families. We believe that the true benefit of RALR may come from increased patient and family satisfaction and quicker return of patients to normal daily activity which will require additional future studies to prove.

Source of Funding: None