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Minimally invasive surgery has helped to achieve shorter hospitalisations, reduce postoperative pain and analgesia requirements and provides better cosmetic results. Robotic urological outpatient surgery has been examined in recent times in the adult population; here Neheman et al. look at the feasibility and safety of such surgery (reconstructive and extirpative) in paediatric patients. The authors performed a retrospective analysis of an institutional database that contained details of all children undergoing robotic surgery. Patients undergoing robotic assisted-pyeloplasty (RAL-P), extravesical ureteric reimplantation (RAL-UR), ureteroureterostomy (RAL-UU) or robotic extirpative surgery e.g., nephrectomy, hemi-nephrectomy and nephrouretectomy, from June 2012 to August 2019 were included. All procedures were performed by two surgeons. Where possible, robotic cases were performed without drains, catheters or double-J stents (to further minimise morbidity / simplify postoperative care). A total of 135 patients underwent robotic outpatient procedures. The majority had reconstructive surgery – 62 patients undergoing RAL-P, 55 patients undergoing RAL-UR and 10 having RAL-UU. Eight patients had extirpative surgery. Median age was 62 months and median weight was 20kg. Overall, there were nine complications (6.7%) of which only one was high grade (Clavien-Dindo 3) and necessitated placement of a double-J stent (for renal colic). There were nine emergency department visits (6.7%) and five cases of readmission (3.7%). The authors have shown for the first time (and in a large number of children) that outpatient robotic surgery is safe and feasible. They noted that many families expressed gratitude for the fact that a hospital stay was not required. The editorial team note that the readmission rate of 3.7% is higher than that of the national average of 0.2% for 30-day readmission rates following ambulatory urological procedures, but perhaps this could be an insight into future trends.

Outpatient robotic surgery in pediatric urology: assessment of feasibility and short-term safety.
Neheman A, Kord E, VanderBrink BA, et al.
2022; 207:894-900.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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