This study explores the safety and feasibility of performing outpatient robotic-assisted urologic surgeries for pediatric patients in a rural setting, specifically West Virginia’s only pediatric urology center. Traditionally, pediatric urologic surgeries require post-operative admission for observation, especially in rural areas with limited healthcare access. However, with advancements in robotics and the goal of expanding outpatient options, this center began transitioning select surgeries to an outpatient model in 2019, standardizing it for non-complex procedures by 2022. This retrospective study included 36 pediatric patients (20 males) who underwent robotic-assisted outpatient procedures from 2019 to 2023. The median age was 66 months, with a range of surgeries performed: partial cystectomy for urachal anomalies, ureteral reimplantation, pyeloplasty, uretero-ureterostomy, nephrectomy, bilateral orchiopexy, Mitrofanoff, and ureterolysis. Patients were managed without narcotics and were generally discharged without Foley catheters, except in cases of severe voiding dysfunction.
Results showed no intraoperative complications, and all patients were successfully discharged directly from the post-anesthesia care unit (PACU). In the first 30 days post-surgery, four patients (11%) visited the emergency department due to fever, urinary retention, or port site erythema. Eight patients (22%) contacted the urology team with questions, though none required additional clinic or ED visits. Phone inquiries were typically about wound care, dysuria, fever, hematuria, pain, or medication reactions. No patients needed readmission or reoperation within 30 days post-surgery. This initial data supports the potential for safe, feasible outpatient pediatric robotic surgeries in rural settings. However, further studies with a larger patient pool are required to confirm these findings and refine protocols for broader application.
