ABSTRACT
OBJECTIVE: We present our experience with pediatric robotic-assisted laparoscopic partial nephrectomy of a nonfunctioning moiety in a duplicated system (RALPN), comparing techniques and outcomes with those previously reported in the literature. To our knowledge, this is the largest series of this surgical procedure to date. PATIENTS AND METHODS: We retrospectively reviewed all pediatric patients at our institution that had undergone RALPN from 2006 to 2012. RESULTS: Twenty-one patients underwent RALPN between 2006 and 2012. Mean patient age was 4.1 years. Mean operative time was 301 min. Mean estimated blood loss was 36 ml. Mean length of stay was 38 h. The majority of cases were performed with three laparoscopic ports. At initial follow-up ultrasound 6/21 (29%) demonstrated a fluid collection. The majority of these collections occurred in cases where the resection defect was not closed intraoperatively (42% of cases vs. 11% of cases). All fluid collections were asymptomatic and managed conservatively. CONCLUSION: RALPN is associated with low complication rates. The robotic system allows for the use of only two small robotic working ports in most cases. Postoperative fluid collections may be prevented by formal closure of the polar defect, but fluid collections that do occur can be followed conservatively.
Subject(s)
Kidney Tubules, Collecting/abnormalities , Kidney Tubules, Collecting/surgery , Nephrectomy/methods , Robotics/methods , Academic Medical Centers , Adolescent , Age Factors , Child , Child, Preschool , Cohort Studies , District of Columbia , Female , Follow-Up Studies , Hospitals, Pediatric , Humans , Infant , Laparoscopy/instrumentation , Laparoscopy/methods , Length of Stay , Male , Minimally Invasive Surgical Procedures/methods , Operative Time , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Retrospective Studies , Sex Factors , Treatment Outcome , Urogenital Abnormalities/diagnosis , Urogenital Abnormalities/surgeryABSTRACT
OBJECTIVE: A novel educational tool, Computer Enhanced Visual Learning (CEVL), has been used to improve resident performance of routine orchiopexy. Our objective was to assess the effect of a CEVL teaching module on the diagnostic accuracy of medical trainees in grading neonatal hydronephrosis on ultrasound using the Society for Fetal Urology (SFU) grading system. METHODS: The authors designed an online-based computerized tutorial to teach the grading of hydronephrosis using multimedia, practice cases and a grading checklist. In a crossover design trial, 29 residents and medical students were asked to grade 16 standard neonatal renal ultrasounds using the SFU grading system before and after viewing the web-based e-learning module. Primary outcome was percent improvement in grading accuracy. RESULTS: The mean percentages of ultrasounds that were graded correctly before and after CEVL intervention were 51% and 72% respectively (mean improvement 21%, 95% CI 3-13%, P < 0.001). Residents graded correctly 56% of ultrasounds before and 74% after CEVL (mean 18%, 7-28%, P = 0.002). Medical students graded correctly 37% before and 69% after CEVL (mean improvement 32%, 95% CI 16-48%, P = 0.002). CONCLUSION: Exposure to a computer-based learning module based on the CEVL platform improved urology residents' and medical students' correct assignment of SFU hydronephrosis grading to newborn renal ultrasounds.
