Presented by: Christopher Connors BA
Icahn School of Medicine at Mount Sinai

Introduction

Partial cystectomy (PC) is a rare procedure in the pediatric population that is most often utilized to treat urachal cysts. PC has traditionally been an open procedure, but technological advancement has led to minimally invasive surgery (MIS) becoming more commonplace. Herein, we present the first study comparing post-operative outcomes between MIS and open PC in children.

Materials

The Pediatric National Surgical Quality Improvement Program (pNSQIP) database was queried for PC from 2012 to 2020. Patients were stratified by MIS or open surgical approach. Demographics, perioperative information, and rates of 30-day surgical outcomes including surgery-related readmissions (SRR), prolonged length of stay (PLOS), and Clavien-Dindo (CD) complications, including reoperations (CD III) were compared between groups. Multivariate regression analysis was used to determine whether a MIS approach was an independent predictor of the surgical outcomes studied. 

Results

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253 cases of PC were identified (Open = 191; MIS = 62). Patients undergoing MIS PC were more likely to be older (5.74 years [2.15 – 9.19] vs. 4.28 years [1.85 – 7.37], p = 0.030) and be female (71.0% vs 53.9%, p = 0.018). All post-operative outcomes of interest were less common in the MIS group when compared to an open approach including CD I/II (1.6 vs 8.9%), reoperations (1.6 vs 4.7%), CD IV (1.6 vs 2.1%), PLOS (22.6 vs 34.0%), and SRR (3.2 vs 5.2%), but these differences were not significant [Figure 1]. Additionally, following multivariate analysis, a MIS approach was not found to be a significant predictor of CD I/II or CD IV complications, PLOS, reoperations, or SRR [Table 1].

Conclusion

MIS and open PC demonstrate comparable post-operative outcomes, suggesting that a MIS approach does not confer additional risk to pediatric patients undergoing PC. Additional research should confirm the safety and efficacy of MIS PC as minimally invasive approaches become more common. 

Funding

None

Lead Authors

Christopher Connors, BA
Icahn School of Medicine at Mount Sinai

Co-Authors

Micah Levy, BS
Icahn School of Medicine at Mount Sinai

Daniel Wang, BS
Icahn School of Medicine at Mount Sinai

Juan Sebastian Arroyave, BS
Icahn School of Medicine at Mount Sinai

Francisca Larenas, MD
Icahn School of Medicine at Mount Sinai

Jeffrey Stock, MD
Icahn School of Medicine at Mount Sinai

Michael Palese, MD
Icahn School of Medicine at Mount Sinai