As robotic surgery's use becomes more widespread in urology's pediatric population, it becomes important to consider and be prepared for possible complications. Robotic technology will also begin to play a role in the management of surgical complications with reoperative procedures that may be facilitated by this approach. As in all surgery, the key to limiting operative adverse events is first prevention, second recognition, and finally management. This chapter is divided into preoperative, intraoperative, and postoperative complications.

Limiting

10.1002/9781118473382.ch20

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V1113 SIMPLIFIED TECHNIQUE FOR ROBOTIC-ASSISTED LAPAROSCOPIC EXTRAVESICAL URETERAL REIMPLANTATION IN CHILDREN

The Journal of Urology (2010)

Philip H. Kim Mukul Patil Justin Lee Roger DeFilippo Andy Chang

You have accessJournal of UrologyPediatrics1 Apr 2010V1113 SIMPLIFIED TECHNIQUE FOR ROBOTIC-ASSISTED LAPAROSCOPIC EXTRAVESICAL URETERAL REIMPLANTATION IN CHILDREN Philip H. Kim, Mukul B. Patil, Justin H. Lee, Roger E. DeFilippo, Andy Y. Chang, Craig A. Peters, Brian E. Hardy, and Chester J. Koh Philip H. KimPhilip H. Kim Los Angeles, CA More articles by this author , Mukul B. PatilMukul B. Patil Los Angeles, CA More articles by this author , Justin H. LeeJustin H. Lee Los Angeles, CA More articles by this author , Roger E. DeFilippoRoger E. DeFilippo Los Angeles, CA More articles by this author , Andy Y. ChangAndy Y. Chang Los Angeles, CA More articles by this author , Craig A. PetersCraig A. Peters Charlottesville, VA More articles by this author , Brian E. HardyBrian E. Hardy Los Angeles, CA More articles by this author , and Chester J. KohChester J. Koh Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic-assisted laparoscopic ureteral reimplantation is an alternative to open surgery for reflux correction in pediatric patients. We describe a simplified, extravesical technique for robotic ureteral reimplantation that incorporates the principles of open anti-reflux surgery. METHODS Robotic extravesical ureteral reimplantation was performed in 25 male and female pediatric patients (22 unilateral, 3 bilateral). Intraoperative videos were reviewed to describe methods for patient positioning, port placement, and surgical technique. Follow-up voiding cystourethrogram (VCUG) results were available for 12 patients (10 unilateral, 2 bilateral). RESULTS Patients were secured in the supine, steep Trendelenburg position. An 8.5 mm camera port was placed at the umbilicus, two 5 mm instrument ports bilaterally, and a 5 mm assistant port in the upper quadrant contralateral to the affected ureter. Upon abdominal entry, the bladder and ureter were identified, along with the uterus, fallopian tube, and ovary in females and the vas deferens in males. After the peritoneum was opened, the ureter was mobilized to gain sufficient length for the reimplantation. A hitch stitch was placed to aid in retraction. A generous extravesical trough was created using electrocautery and careful blunt dissection. Reimplantation was performed in a “top-down” approach, with the first suture placed at the superior aspect of the extravesical trough. This creates a new muscle hiatus, facilitates subsequent suture placement, and assists in ureteral retraction. The detrusor was reapproximated with interrupted sutures, providing a muscular backing and an anti-reflux mechanism. The muscle hiatus was checked for patency, and the ureter gently manipulated to ensure mobility and absence of kinking. Before peritoneal closure, these maneuvers were repeated with the bladder filled to further assure the integrity of the repair. All patients with follow-up VCUG demonstrated improvement – 10 had complete resolution; 2 had grade I reflux. There were no intraoperative or postoperative complications. To date, there have been no postoperative urinary tract infections. CONCLUSIONS Our technique for robotic extravesical reimplantation adapts the fundamentals of open surgery to a minimally-invasive approach. This simplified method demonstrates the ability to perform minimally-invasive reconstructive urologic surgery for pediatric patients. Although more follow-up is needed, our initial results suggest cure rates that approach those of standard open extravesical reimplantation. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e431-e432 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Philip H. Kim Los Angeles, CA More articles by this author Mukul B. Patil Los Angeles, CA More articles by this author Justin H. Lee Los Angeles, CA More articles by this author Roger E. DeFilippo Los Angeles, CA More articles by this author Andy Y. Chang Los Angeles, CA More articles by this author Craig A. Peters Charlottesville, VA More articles by this author Brian E. Hardy Los Angeles, CA More articles by this author Chester J. Koh Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Open surgery

10.1016/j.juro.2010.02.2310

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Bladder management in children with transverse myelitis

Journal of Pediatric Urology (2021)

Arthi Hannallah Niccolò Passoni Craig A. Peters Nabeel Shakir Benjamin Greenberg

Urinary retention

Clean Intermittent Catheterization

Demographics

Presentation (obstetrics)

10.1016/j.jpurol.2021.04.003

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Faculty Opinions recommendation of Vesicoureteral Reflux Index: Predicting Primary Vesicoureteral Reflux Resolution in Children Diagnosed after Age 24 Months.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature (2018)

Craig A. Peters

10.3410/f.727097363.793554493

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Box Stitch Modification of Hasson Technique for Pediatric Laparoscopy

Journal of Endourology (1999)

Dix P. Poppas Clifford B. Bleustein Craig A. Peters

Laparoscopy has been recognized as the modality of choice for the treatment of many diseases in urology, gynecology, and general surgery. Although laparoscopy is minimally invasive, the most frequent complications are associated with entry through the abdominal wall. The Hasson (open) technique was developed to minimize the complications by entering the abdomen under direct vision. We have modified the Hasson technique with a stitch that is easy to perform, creates a tight fascial seal, allows easy exchange of trocars, and produces an effect that is cosmetically appealing.

10.1089/end.1999.13.447

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Faculty Opinions recommendation of NICE Guidelines Cannot Be Recommended for Imaging Studies in Children Younger Than 3 Years with Urinary Tract Infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature (2014)

Craig A. Peters

Nice

10.3410/f.718515625.793500805

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The Condition-Dependent Development of Carotenoid-Based and Structural Plumage in Nestling Blue Tits: Males and Females Differ

The American Naturalist (2007)

Craig A. Peters Delhey Johnsen Kempenaers

Despite the importance of proximate mechanisms for understanding costs and functions of signals, relatively little is known about physiological processes underlying colorful plumage production. We investigated yellow carotenoid‐based breast plumage and ultraviolet (UV)/blue structural color of tail feathers in nestling blue tits. At peak plumage production and at fledging, we examined plasma concentration of protein, the substance of feathers, and levels of carotenoids, which are deposited in yellow plumage and also required for support of growth and immune development. Males showed more UV‐shifted hue and higher chroma and UV chroma of the tail feathers. In males only, tail chroma and UV chroma were strongly but negatively related to circulating plasma protein at the period of peak feather production. Breast plumage was more chromatic in males, and yellow coloration was strongly condition dependent in males only. Production of more chromatic plumage appeared to deplete carotenoids from plasma, since male fledglings had less circulating carotenoids than females. This had no obvious consequences for these males, since coloration was unrelated to cell‐mediated immune responses, humoral immune status, stress, and parasitism. Nonetheless, the pronounced sex specificity of condition dependence of structural and carotenoid‐based coloration is suggestive of a signaling function of the fledgling plumage.

Plumage

Fledge

10.2307/4125306

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Congenital bladder obstruction

Craig A. Peters

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