Schwentner Christian, Pelzer Alexandre, Neururer Richard, Springer Brigitte, Horninger Wolfgang, Bartsch Georg, Peschel Reinhard
Department of Urology, Medical University, Innsbruck, Austria.
BJU Int. 2007 Oct;100(4):880-5. doi: 10.1111/j.1464-410X.2007.07032.x. Epub 2007 May 29.
To present our 5-year experience with robotically assisted laparoscopic pyeloplasty (RALP), as LP has been shown to have similar success rates as open surgery, but standard LP requires high operative skills and a correspondingly long period of training, limiting its widespread availability, and RALP is easier and quicker to learn due to facilitated intracorporeal suturing.
In all, 92 patients had transperitoneal RALP for pelvi-ureteric junction obstruction (PUJO) using the daVinci system (Intuitive Surgical, Sunnyvale, CA, USA). A transperitoneal dismembered Anderson-Hynes procedure was used in all cases. Three robotic ports and one assistant port were used in all cases while a JJ stent was left indwelling for 6 weeks. Both primary PUJO (including horseshoe kidneys in 80 cases) and secondary (in 12 cases) were considered eligible. The follow-up included ultrasonography, excretory urography and renal scintigraphy.
The mean follow-up was 39.1 months; PUJO was successfully resolved in 89 patients (96.7%) while three required additional procedures. Haemorrhage into the collecting system and urine extravasation occurring early after surgery were the causes of failure. The mean (range) operative duration, including the set-up of the robot, was 108.34 (72-215) min; the mean duration of docking and surgery significantly decreased with experience (P < 0.001). The mean hospital stay was 4.57 days. Split renal function improved from 37.6% to 41.9%. No cases of secondary PUJO were recorded during extended follow-up.
RALP using the daVinci system is safe and effective, achieving similar long-term success rates to open surgery. The three-dimensional versatility of the robot enables the surgeon to recapitulate the open procedure. The results were durable with no cases of late complications, corroborating the accuracy of robot-assisted intracorporeal suturing and the subsequent quality of the pelvi-ureteric anastomosis. Moreover, the robotic approach was easy and quick to learn for both the surgical and the technical staff. Therefore, RALP is our preferred technique to treat PUJO.
介绍我们在机器人辅助腹腔镜肾盂成形术（RALP）方面的5年经验，因为腹腔镜肾盂成形术（LP）已被证明与开放手术成功率相似，但标准的LP需要较高的手术技巧和相应较长的培训时间，限制了其广泛应用，而由于体内缝合更容易且更快掌握，RALP更容易学习。
总共92例患者使用达芬奇系统（美国加利福尼亚州森尼韦尔市直观外科公司）经腹膜进行RALP治疗肾盂输尿管连接部梗阻（PUJO）。所有病例均采用经腹膜离断性安德森-海恩斯手术。所有病例均使用3个机器人端口和1个辅助端口，同时留置双J支架6周。原发性PUJO（包括80例马蹄肾）和继发性PUJO（12例）均被视为符合条件。随访包括超声检查、排泄性尿路造影和肾闪烁显像。
平均随访39.1个月；89例患者（96.7%）的PUJO成功解决，3例需要额外手术。手术早期发生的集合系统出血和尿液外渗是失败的原因。包括机器人设置在内的平均手术时间为108.34（72 - 215）分钟；随着经验的增加，对接和手术的平均时间显著缩短（P < 0.001）。平均住院时间为4.57天。分肾功能从37.6%提高到41.9%。在延长随访期间未记录到继发性PUJO病例。
使用达芬奇系统的RALP安全有效，长期成功率与开放手术相似。机器人的三维多功能性使外科医生能够重现开放手术过程。结果持久，无晚期并发症病例，证实了机器人辅助体内缝合的准确性以及随后肾盂输尿管吻合的质量。此外，机器人手术方法对外科医生和技术人员来说都容易且快速掌握。因此，RALP是我们治疗PUJO的首选技术。
