Atug Fatih, Woods Michael, Burgess Scott V, Castle Erik P, Thomas Raju
Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
J Urol. 2005 Oct;174(4 Pt 1):1440-2. doi: 10.1097/01.ju.0000173131.64558.c9.
Historically, open pyeloplasty has been the gold standard of treatment for ureteropelvic junction obstruction in the pediatric age group. The prospect of using technology such as the robot in this age group has been a concern. Several non-urological robotic procedures have been performed in children. We undertook a retrospective study to evaluate the feasibility and outcomes of robotic assisted laparoscopic pyeloplasty in the pediatric population.
Seven patients 6 to 15 years old underwent robotic assisted laparoscopic pyeloplasty at our institution between June 2003 and November 2004. All patients underwent dismembered pyeloplasty (Anderson-Hynes). Variables analyzed included length of stay, estimated blood loss, operative time, anastomosis time and docked robotic time.
Mean followup was 10.9 months (range 2 to 18). Mean length of stay was 1.2 days (range 1 to 3). Mean operative time was 184 minutes (range 165 to 204), with a mean robotic anastomosis time of 39.5 minutes (30 to 46). Mean estimated blood loss was 31.4 ml (range 10 to 50). Stent size varied from 3.8Fr to 6Fr. Six of the 7 patients have had followup studies demonstrating improved drainage, symptom resolution and no evidence of obstruction on diuretic renal scans or excretory urogram. The remaining patient is awaiting 3-month followup evaluation.
Robotic assisted pyeloplasty can be safely performed in the pediatric population. The precision in dissection, incision and suturing allows for comparable results to open pyeloplasty in this age group.
从历史上看，开放性肾盂成形术一直是小儿输尿管肾盂连接部梗阻治疗的金标准。在这个年龄组使用机器人等技术的前景一直是个令人担忧的问题。已经在儿童中进行了一些非泌尿外科的机器人手术。我们进行了一项回顾性研究，以评估机器人辅助腹腔镜肾盂成形术在小儿患者中的可行性和疗效。
2003年6月至2004年11月期间，7例6至15岁的患者在我们机构接受了机器人辅助腹腔镜肾盂成形术。所有患者均接受了离断性肾盂成形术（安德森-海因斯术式）。分析的变量包括住院时间、估计失血量、手术时间、吻合时间和机器人对接时间。
平均随访时间为10.9个月（范围2至18个月）。平均住院时间为1.2天（范围1至3天）。平均手术时间为184分钟（范围165至204分钟），平均机器人吻合时间为39.5分钟（30至46分钟）。平均估计失血量为31.4毫升（范围10至50毫升）。支架尺寸从3.8Fr到6Fr不等。7例患者中有6例进行了随访研究，结果显示引流改善、症状缓解，利尿肾图或排泄性尿路造影未发现梗阻迹象。其余1例患者正在等待3个月的随访评估。
机器人辅助肾盂成形术可在小儿患者中安全进行。在解剖、切割和缝合方面的精确性使得该年龄组的手术效果与开放性肾盂成形术相当。
