Minimally Invasive Surgery (MIS) has been gaining momentum in pediatric urology and it is essential to analyze the unique complications pertinent to this approach. Here, we conducted a systematic review to evaluate pediatric MIS complications in the published urologic literature.
We searched PubMed/MEDLINE using relevant pediatric MIS terminology and applied specified eligibility criteria. The Clavien-Dindo (CD) classification scheme was used to categorize post-operative complications. For studies not utilizing CD, complications were re-categorized into CD grades. Primary outcome was frequency of Grade III complications and conversions to open. Covariates were surgery type (pyeloplasty, nephrectomy, partial nephrectomy, ureteral reimplantation, and complex reconstructions) and surgical approach (laparoscopic, robotic-assisted, and/or laparoendoscopic single site). Proportions were compared using the chi-square test (α=0.05).
In all, 123 studies met inclusion criteria, reporting outcomes of 5864 patients. About a third (35.8%) of studies utilized the CD classification. Nephrectomies had a significantly lower frequency of Grade III complications (1.18%) compared to pyeloplasties (3.64%), ureteral reimplantations (6.65%), and complex reconstructions (11.76%) (P<0.05). Complex reconstructions had a significantly higher frequency of Grade III complications (11.39%) compared to all other analyzed surgeries (P<0.05).
The rate of complications and open conversions vary by surgical procedure in pediatric urologic MIS. Despite the existence of a standardized complication classification system, the majority of reviewed publications did not report complications in a standardized fashion. Our findings call for more robust studies in pediatric MIS and universal implementation of standardized complication reporting.