Gettman Matthew T, Peschel Reinhard, Neururer Richard, Bartsch Georg
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2002 Nov;42(5):453-7; discussion 457-8. doi: 10.1016/s0302-2838(02)00373-1.
Laparoscopic pyeloplasty is an accepted therapy for primary ureteropelvic junction obstruction (UPJO), however difficulty associated with intracorporeal suturing has limited widespread clinical application. We report our initial experience of laparoscopic pyeloplasty performed with the daVinci robotic system matched to procedures performed with standard laparoscopic techniques.
From June 2001 until August 2001, six patients underwent definitive management of primary UPJO using the daVinci robotic system. In four patients an Anderson-Hynes pyeloplasty was performed, while in two patients Fengerplasty was performed. Using demographic and preoperative information, each patient in the daVinci-assisted group was matched to a corresponding patient with primary UPJO undergoing laparoscopic pyeloplasty with standard techniques between November 1999 and June 2001. Perioperative results and follow-up data were subsequently compared.
Treatment groups were identical with regard to surgical procedure, gender, and side of UPJO. The length of hospitalization was 4 days for all patients, regardless of treatment group. Estimated blood loss was <50 cc in all cases. For Anderson-Hynes pyeloplasty, the mean overall operative and suturing times were 140 and 70 min using the daVinci system and 235 and 120 min using standard techniques, respectively. For the Fengerplasty, the mean overall operative and suturing times were 78 and 13 minutes using the daVinci system and 100 and 28 minutes using standard techniques, respectively. No complications were observed and there were no open conversions.
Anderson-Hynes pyeloplasty and Fengerplasty are feasible using either conventional laparoscopic techniques or the daVinci robotic system. In this initial pilot study, procedures performed with the daVinci robotic system resulted in overall decreased operative time, however factors responsible for the decreased operative time remain to be defined. Long-term prospective follow-up of procedures performed with or without the daVinci robotic system for surgeons with limited experience in laparoscopic management of UPJO is warranted to delineate the true efficacy of the device.
腹腔镜肾盂成形术是治疗原发性肾盂输尿管连接部梗阻（UPJO）的一种公认疗法，然而与体内缝合相关的困难限制了其在临床上的广泛应用。我们报告了使用达芬奇机器人系统进行腹腔镜肾盂成形术的初步经验，并与采用标准腹腔镜技术进行的手术进行了对比。
2001年6月至2001年8月，6例患者使用达芬奇机器人系统对原发性UPJO进行了确定性治疗。4例患者接受了安德森-海恩斯肾盂成形术，2例患者接受了芬格成形术。利用人口统计学和术前信息，将达芬奇辅助组的每例患者与1999年11月至2001年6月期间采用标准技术接受腹腔镜肾盂成形术的原发性UPJO患者进行匹配。随后比较围手术期结果和随访数据。
治疗组在手术方式、性别和UPJO侧别方面相同。所有患者的住院时间均为4天，与治疗组无关。所有病例的估计失血量均<50 cc。对于安德森-海恩斯肾盂成形术，使用达芬奇系统时平均总手术时间和缝合时间分别为140分钟和70分钟，使用标准技术时分别为235分钟和120分钟。对于芬格成形术，使用达芬奇系统时平均总手术时间和缝合时间分别为78分钟和13分钟，使用标准技术时分别为100分钟和28分钟。未观察到并发症，也没有转为开放手术。
使用传统腹腔镜技术或达芬奇机器人系统进行安德森-海恩斯肾盂成形术和芬格成形术都是可行的。在这项初步的试点研究中，使用达芬奇机器人系统进行的手术总体手术时间缩短，然而导致手术时间缩短的因素仍有待确定。对于在UPJO腹腔镜治疗方面经验有限的外科医生，对使用或不使用达芬奇机器人系统进行的手术进行长期前瞻性随访，以明确该设备的真正疗效是有必要的。
