Our Summary

This research paper describes a study conducted on children who required a specific type of surgical procedure called robotic uretero-ureterostomy (RUU). This is a minimally invasive type of surgery mainly used to treat a condition called duplex systems, where there are two ureters - the tubes that carry urine from the kidneys to the bladder - coming from one or both kidneys.

The study used a surgical robot called the Da Vinci Surgical Robot Xi® to perform these procedures between November 2018 and December 2023. Before the surgery, patients underwent ultrasound and other diagnostic tests. The surgery was conducted by placing three or four small surgical tools (trocars) along the patient’s belly button line while they were in a slightly head-down position.

Eight children (7 girls and 1 boy) underwent the surgery. The median age was 4.4 years and median weight was 15.8 kg. The surgery took an average of around 130 minutes, with the robot being controlled for about 66 minutes.

All patients had a small tube (stent) inserted in their ureter for an average of 45.5 days after the surgery. There were no complications during the surgery and none of the surgeries had to be converted to an open surgical procedure. Patients stayed in the hospital for an average of 3 days and were followed up for an average of 7 months.

The surgery was successful for all patients, as shown by the resolution of urinary incontinence (involuntary leakage of urine) and reduced or resolved urinary dilation (swelling of the kidneys due to buildup of urine).

The study concludes that RUU is a safe and effective alternative to other more invasive surgeries for treating duplex systems, even in smaller, lighter children.

FAQs

  1. What is robotic uretero-ureterostomy (RUU) and what condition does it treat?
  2. How was the Da Vinci Surgical Robot Xi® used in the study and what were the results?
  3. What are the benefits of using RUU as an alternative to other more invasive surgeries for treating duplex systems?

Doctor’s Tip

A helpful tip a doctor might tell a patient about ureterostomy is to closely follow the post-operative instructions provided by the medical team. This may include taking prescribed medications, keeping the stent in place for the recommended duration, staying hydrated, and avoiding heavy lifting or strenuous activities during the recovery period. It is important to attend all follow-up appointments to monitor healing and address any concerns promptly.

Suitable For

Patients who are typically recommended ureterostomy, specifically robotic uretero-ureterostomy, include children with duplex systems, where there are two ureters coming from one or both kidneys. These patients may experience urinary incontinence and urinary dilation, which can be effectively treated with this minimally invasive surgical procedure. In the study mentioned above, children as young as 4.4 years old and weighing as little as 15.8 kg successfully underwent RUU, demonstrating that this procedure can be considered for a wide range of pediatric patients with duplex systems.

Timeline

Overall, the timeline for a patient undergoing ureterostomy surgery includes:

  • Diagnostic tests such as ultrasound before the surgery
  • Placement of trocars and robot-assisted surgery, lasting around 130 minutes
  • Insertion of a stent in the ureter for an average of 45.5 days post-surgery
  • Hospital stay for an average of 3 days
  • Follow-up for an average of 7 months after the surgery

After the surgery, patients experience resolution of urinary incontinence and reduced or resolved urinary dilation, indicating the success of the procedure in treating duplex systems.

What to Ask Your Doctor

  1. What is the specific reason for recommending ureterostomy surgery in my case?
  2. What are the potential risks and complications associated with ureterostomy surgery?
  3. How long is the recovery period after ureterostomy surgery?
  4. Will I need to make any lifestyle changes or follow any special precautions after the surgery?
  5. How often will I need follow-up appointments after the surgery?
  6. Are there any long-term effects or potential complications I should be aware of?
  7. What are the success rates of ureterostomy surgery in treating my specific condition?
  8. Are there any alternative treatment options available for my condition?
  9. How experienced are you in performing robotic uretero-ureterostomy surgeries?
  10. Can you provide me with more information on the specific surgical robot and technique that will be used for my surgery?

Reference

Authors: Monti M, Rotondi G, Carlucci M, Fiorenza V, Mattioli G. Journal: J Pediatr Urol. 2025 Jun;21(3):779-780. doi: 10.1016/j.jpurol.2025.02.007. Epub 2025 Feb 12. PMID: 40016015