Pereira Arias José Gregorio, Gamarra Quintanilla Mikel, Gallego Sánchez José Antonio, Camargo Ibergaray Isabel, Astobieta Odriozola Ander, Ibarluzea González Gaspar
Urología Clínica, Clínica Virgen Blanca, Bilbao, Vizcaya, España.
Arch Esp Urol. 2007 May;60(4):449-61. doi: 10.4321/s0004-06142007000400015.
The treatment of ureteropyelic junction (UPJ) obstruction offers a perfect sketch of the parallel evolution of the availability of technology and changes in surgical proceedings. From the open Anderson-Hynes pyeloplasty, passing through percutaneous or retrograde endopyelothomy with various instruments, to the laparoscopic approach, technology and human talent have found a field for development in this reconstructive procedure. Robotic surgery is young and starts to define its role in urology surgery. There are established procedures such as radical prostatectomy; it remains to be established what operations will benefit from the robotic technology, so results are under continuous evaluation. The non stopping advance of computer technology guarantees future achievements of robotic technology. The objective is to achieve that surgeons could perform difficult surgical procedures with a level of accuracy and clinical results that would be difficult to achieve with conventional methods. We analyze the technical features, results and comparative studies of the robotic pyeloplasty from the medical literature. Robotic surgery has demonstrated its usefulness in the performance of pyeloplasties, with good results in primary and secondary UPJ stenosis in children and adults, in various aetiologies. Robotics enables to diminish the difficulties of intracorporeal suture and the learning curve for surgeons without laparoscopic experience. Nevertheless, although initial clinical experience with robotic pyeloplasty is favourable, continuous evaluation of results is necessary to determine if the surgical procedure is as effective in the long-term as laparoscopic and open pyeloplasty.
输尿管肾盂连接部(UPJ)梗阻的治疗展现了技术可用性与手术操作变化同步发展的完美概况。从开放性安德森 - 海恩斯肾盂成形术,历经使用各种器械的经皮或逆行肾盂内切开术,再到腹腔镜手术方法,技术和人才在这种重建手术中找到了发展空间。机器人手术尚年轻,正开始在泌尿外科手术中明确自身角色。像根治性前列腺切除术这类手术已确立;而哪些手术将从机器人技术中受益还有待确定,因此其结果仍在持续评估中。计算机技术的不断进步保证了机器人技术未来会取得成就。目标是让外科医生能够以传统方法难以达到的精准度和临床效果来实施困难的外科手术。我们从医学文献中分析机器人肾盂成形术的技术特点、结果及对比研究。机器人手术已证明其在肾盂成形术中的有效性,在儿童和成人原发性及继发性UPJ狭窄的各种病因中都取得了良好效果。机器人技术能够减少体内缝合的难度,并降低没有腹腔镜经验的外科医生的学习曲线。然而,尽管机器人肾盂成形术的初步临床经验是积极的,但仍需持续评估结果,以确定该手术在长期是否与腹腔镜和开放性肾盂成形术一样有效。