Paediatric Robotic Transperitoneal Heminephroureterectomy in Complete Duplicated Systems: Early and Long-Term Outcomes

Background: We present outcomes for paediatric robotic heminephroureterectomy from a prospective single-surgeon series. Methods: Children who underwent this operation between July 2007 and March 2017 were reviewed from a prospective database. Results: There were 32 heminephroureterectomy (28 upper, 4 lower) for ureterocele (13), reflux (7), ectopic ureter (11), ureteric atresia (1). Co-morbidities (urological anomalies, recurrent infection, previous abdominal scarring) were common. Concomitant non-robotic procedures took place in 50%. Mean console time was 101 ± 30.2 min, hospital stay 29.5 ± 10.3 h. There were no conversions, intraoperative complications, and no remnant moiety function loss. Excision of diseased moiety calyces was complete in 30 (94%), incomplete in 2 (6%) who subsequently developed asymptomatic small marginal cysts. Eleven (34%) had total-ureterectomy, the remaining 21 (66%) were left with a ureteric stump. Postoperatively 3 (9%) females with residual stump (2 ureterocele, 1 bladder neck ectopia) and other urological anomalies underwent surgery (stump excision + reimplant refluxing remnant moiety ureter) for recurrent infection. Conclusion: In children, heminephroureterectomy is well suited to a robotic approach with favourable outcomes in our experience.