Division of Urology, McMaster University, Hamilton, Ontario, Canada.
Eur Urol. 2009 Nov;56(5):848-57. doi: 10.1016/j.eururo.2009.03.063. Epub 2009 Apr 1.
Although robotic-assisted procedures may theoretically be more advantageous than conventional laparoscopic ones, few studies have shown clear superiority of robotic-assisted laparoscopic pyeloplasty (RAP) over conventional laparoscopic pyeloplasty (CLP) for ureteropelvic junction obstruction (UPJO).
To undertake a systematic review and meta-analysis to evaluate the effect of RAP versus CLP for patients with UPJO, focusing on operative time, length of hospital stay, postoperative complications, and success rate.
DESIGN, SETTING, AND PARTICIPANTS: We searched four electronic bibliographic databases, including the related articles PubMed feature, reference lists from articles, and program abstracts from scientific meetings. Consequently, 58 citations were identified. Two individuals independently screened the titles and abstracts of each citation to select the articles (90% agreement).
Studies that compared RAP with CLP for treatment of UPJO were included. Case series on RAP or CLP were excluded because of large heterogeneity.
We utilized weighted mean difference (WMD) to measure operative time and length of hospital stay and odds ratio (OR) and risk difference (RD) to measure complication and success rates. These ORs were pooled using a random effects model and were tested for heterogeneity.
We identified eight publications that strictly met our eligibility criteria. Meta-analysis of extractable data showed that RAP was associated with a 10-min operative time reduction (WMD: -10.4 min; 95% CI: -24.6-3; p=0.15) and significantly shorter hospital stay compared with CLP (WMD: -0.5 d; 95% CI: -0.6-0.4; p<0.01). There were no differences between the approaches with regard to rates of complication (OR: 0.7; 95% CI: 0.3-1.6; p=0.40) and success (OR: 1.3; 95% CI: 0.5-3.5; p=0.62).
RAP and CLP appear to be equivalent with regard to postoperative urinary leaks, hospital readmissions, success rates, and operative time.
虽然机器人辅助手术在理论上可能比传统腹腔镜手术更有优势，但很少有研究表明机器人辅助腹腔镜肾盂成形术（RAP）在治疗肾盂输尿管连接部梗阻（UPJO）方面明显优于传统腹腔镜肾盂成形术（CLP）。
进行系统评价和荟萃分析，以评估 RAP 与 CLP 治疗 UPJO 的效果，重点关注手术时间、住院时间、术后并发症和成功率。
设计、地点和参与者：我们检索了四个电子文献数据库，包括 PubMed 特色相关文章、文章参考文献列表和科学会议项目摘要。因此，确定了 58 篇引文。两名研究人员独立筛选了每篇引文的标题和摘要以选择文章（90%的一致性）。
纳入了比较 RAP 与 CLP 治疗 UPJO 的研究。由于异质性较大，排除了关于 RAP 或 CLP 的病例系列研究。
我们使用加权均数差（WMD）来衡量手术时间和住院时间，使用比值比（OR）和风险差（RD）来衡量并发症和成功率。使用随机效应模型对这些 OR 进行汇总，并进行了异质性检验。
我们确定了 8 篇严格符合我们入选标准的出版物。可提取数据的荟萃分析显示，RAP 与 CLP 相比，手术时间缩短了 10 分钟（WMD：-10.4 分钟；95%CI：-24.6-3；p=0.15），住院时间明显缩短（WMD：-0.5 天；95%CI：-0.6-0.4；p<0.01）。两种方法在并发症发生率（OR：0.7；95%CI：0.3-1.6；p=0.40）和成功率（OR：1.3；95%CI：0.5-3.5；p=0.62）方面没有差异。
RAP 和 CLP 在术后尿漏、住院再入院、成功率和手术时间方面似乎相似。
