Badalato Gina M, Hemal Ashok K, Menon Mani, Badani Ketan K
Department of Urology, Columbia University College of Physicians and Surgeons , New York, NY, USA.
J Endourol. 2009 Oct;23(10):1719-22. doi: 10.1089/end.2009.1540.
The scope of robot-assisted surgery continues to expand with the application of these systems to management of large upper-tract urinary stones, with or without concomitant pyeloplasty. The known advantages of the robot-assisted approach, including enhanced optics, dexterity, wristed instrumentation, and ergonomics, can facilitate complex reconstruction of the collecting system, including uteropelvic junction repair. With the favorable outcomes of contemporary robot-assisted pyeloplasty series, robot-assisted applications have been translated to pyelolithotomy with or without concomitant upper-tract reconstruction. The early results of robot-assisted lithotomy reveal the procedure is a safe and efficacious approach for patients with large renal stones; nevertheless, the technique has met limited success in cases of large staghorn calculi. Our purpose was to evaluate the current role of robot-assisted pyelolithotomy for the management of large renal calculi.
Given the known advantages of the robotic system in conjunction with its reconstructive capabilities, the applications of robot-assisted pyelolithotomy, although encouraging, warrant further longitudinal, multi-institutional investigation. This technique is in its early stage of implementation and randomized trials that compare robot-assisted outcomes with other minimally invasive techniques are needed to define clinical efficacy as it pertains to subsets of patients with variable stone size, location, and consistency.
随着机器人辅助手术系统应用于伴有或不伴有肾盂成形术的大型上尿路结石治疗，其应用范围不断扩大。机器人辅助手术方法的已知优势，包括增强的光学效果、灵活性、腕式器械以及人体工程学设计，有助于包括肾盂输尿管连接部修复在内的集合系统的复杂重建。鉴于当代机器人辅助肾盂成形术系列取得的良好效果，机器人辅助应用已扩展至伴有或不伴有上尿路重建的肾盂切开取石术。机器人辅助取石术的早期结果表明，该手术对于大肾结石患者是一种安全有效的方法；然而，该技术在治疗大型鹿角形结石病例中取得的成功有限。我们的目的是评估机器人辅助肾盂切开取石术在大型肾结石治疗中的当前作用。
鉴于机器人系统的已知优势及其重建能力，机器人辅助肾盂切开取石术的应用虽令人鼓舞，但仍需进一步进行纵向、多机构研究。该技术尚处于实施初期，需要进行随机试验，将机器人辅助手术的结果与其他微创技术进行比较，以确定其在不同结石大小、位置和质地的患者亚组中的临床疗效。
