Presentation Authors: Leonid Aksenov*, Durham, NC, Candace Granberg, Patricio Gargollo, Rochester, MN
Introduction: Minimally Invasive Surgery (MIS) has been gaining momentum in pediatric urology as a result of faster recovery, decreased post-operative pain, and improved cosmesis. In the era of quality outcomes, it is essential to analyze the unique complications in pediatric MIS. Given this context, we critically evaluated pediatric MIS complications in the published urologic literature.
Methods: We searched the English medical literature using the key words &[Prime]pediatric,&[Prime] &[Prime]laparoscopic,&[Prime] &[Prime]robotic,&[Prime] and surgery-specific terms (e.g. &[Prime]nephrectomy&[Prime]). We also consulted the references in articles, reviews, and meta-analyses for additional studies. Only studies with clear reporting of complications and open conversions were included. Post-operative complications were categorized using the Clavien-Dindo classification scheme (Grade I-II, IIIa-IIb, or IV+). If a study did not use this classification, reported complications were categorized into Clavien-Dindo grades. Proportions were compared using the chi-square test.
Results: A total of 169 articles were identified. Less than a fifth (18.9%) of the studies utilized the Clavien-Dindo classification system. The remaining studies (81.1%) did not use any standardized complication reporting, requiring categorization of complications to Clavien-Dindo grades. Table 1 shows the open conversion and complication rates of various MIS subdivided by technique. Notably, reconstructive operations had the highest rate of open conversions and complications while nephrectomies had the lowest rate of complications (Figure 1).
Conclusions: The rates of open conversions and complications vary by surgery in pediatric urologic MIS. Furthermore, despite the existence of a standardized complication classification system, a large majority of reviewed publications did not report complications in a standardized fashion. Our findings call for more robust studies in pediatric MIS and for universal implementation of standardized complication reporting in order to accurately assess the utilization of MIS in pediatric urology.