Use of Pediatric Open, Laparoscopic and Robot-Assisted Laparoscopic Ureteral Reimplantation in the United States: 2000 to 2012

作者：Bowen Diana K; Faasse Mark A; Liu Dennis B; Gong Edward M; Lindgren Bruce W; Johnson Emilie K^*

来源：Journal of Urology, 2016, 196(1): 207-212.

DOI：10.1016/j.juro.2016.02.065

• pediatrics
• replantation
• robotics
• urologic surgical procedures
• vesico-ureteral reflux

Purpose: We characterize the use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States from 2000 to 2012.
Materials and Methods: We used the Kids' Inpatient Database to identify patients who underwent ureteral reimplantation for primary vesicoureteral reflux. Before 2009 laparoscopic ureteral reimplantion and robot-assisted laparoscopic ureteral reimplantation were referred to together as minimally invasive ureteral reimplantation. A detailed analysis of open vs robot-assisted laparoscopic ureteral reimplantation was performed for 2009 and 2012.
Results: A total of 14,581 ureteral reimplantations were performed. The number of ureteral reimplantations yearly decreased by 14.3%. However, the proportion of minimally invasive ureteral reimplantations increased from 0.3% to 6.3%. A total of 125 robot-assisted laparoscopic ureteral reimplantations were performed in 2012 (81.2% of minimally invasive ureteral reimplantations), representing 5.1% of all ureteral reimplantations, compared to 3.8% in 2009. In 2009 and 2012 mean +/- SD patient age was 5.7 +/- 3.6 years for robot-assisted laparoscopic ureteral reimplantation and 4.3 +/- 3.3 years for open reimplantation (p < 0.0001). Mean +/- SD length of hospitalization was 1.6 +/- 1.3 days for robot-assisted laparoscopic ureteral reimplantation and 2.4 +/- 2.6 for open reimplantation (p < 0.0001). Median charges were $22,703 for open and $32,409 for robot-assisted laparoscopic ureteral reimplantation (p < 0.0001). These relationships maintained significance on multivariate analyses. On multivariate analysis robot-assisted laparoscopic ureteral reimplantation use was associated with public insurance status (p = 0.04) and geographic region outside of the southern United States (p = 0.02). Only 50 of 456 hospitals used both approaches (open and robotic), and only 6 hospitals reported 5 or more robot-assisted laparoscopic ureteral reimplantations during 2012.
Conclusions: Treatment of primary vesicoureteral reflux with ureteral reimplantation is decreasing. Robot-assisted laparoscopic ureteral reimplantation is becoming more prevalent but remains relatively uncommon. Length of stay is shorter for the robotic approach but the costs are higher. Nationally robot-assisted laparoscopic ureteral reimplantation appears to still be in the early phase of adoption and is clustered at a small number of hospitals.

• 出版日期2016-7
• 单位西北大学