Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Urol. 2010 Feb;183(2):704-8. doi: 10.1016/j.juro.2009.10.040. Epub 2009 Dec 21.
Since its inception, robot assisted laparoscopic pyeloplasty has rapidly become the minimally invasive surgical intervention of choice for treating ureteropelvic junction obstruction at our institution. The large initial investment in robot assisted surgery is frequently justified by its association with improved optics and instrument articulation, decreased postoperative pain, shorter length of hospitalization and improved cosmesis. However, there are no data specifically showing patient satisfaction with robot assisted laparoscopic pyeloplasty compared to traditional open surgery.
A previously validated satisfaction survey (Glasgow Children's Benefit Inventory) with 14 additional questions specifically addressing postoperative satisfaction was mailed to all parents (as patient proxy) of children who had undergone open or robot assisted laparoscopic pyeloplasty between January 2006 and December 2008.
A total of 78 parents responded (response rate 70%). All responses achieving statistical significance favored robot assisted laparoscopic pyeloplasty. Parents of children who underwent robot assisted laparoscopic pyeloplasty reported significantly higher satisfaction with "overall life," confidence, self-esteem, burden of postoperative followup and size of incision scar.
Parent satisfaction was greater with robot assisted laparoscopic pyeloplasty than with open surgery regarding amount of cosmesis and recovery. Interestingly the differences in satisfaction were not as large as anticipated, suggesting the impact of confounding factors such as age and preoperative parental expectations. Future large-scale prospective studies using validated surveys specific to pediatric surgery are needed to elucidate further the true benefits of minimally invasive surgical technology such as robot assistance.
自创立以来，机器人辅助腹腔镜肾盂成形术迅速成为我们机构治疗肾盂输尿管连接部梗阻的微创首选治疗方法。机器人辅助手术的巨额初始投资通常可以通过其与改善的光学和器械铰接、减少术后疼痛、缩短住院时间和改善美容效果相关联而得到证明。然而，没有数据专门显示与传统开放手术相比，机器人辅助腹腔镜肾盂成形术的患者满意度。
对 2006 年 1 月至 2008 年 12 月期间接受开放或机器人辅助腹腔镜肾盂成形术的所有儿童的父母（作为患者代理人），使用先前验证的满意度调查（格拉斯哥儿童福利量表）进行了调查，并增加了 14 个专门针对术后满意度的问题。
共有 78 位家长（回复率 70%）做出了回应。所有有统计学意义的结果都支持机器人辅助腹腔镜肾盂成形术。接受机器人辅助腹腔镜肾盂成形术的儿童的父母报告说，在“整体生活”、信心、自尊、术后随访负担和切口疤痕大小方面的满意度明显更高。
在美容和恢复方面，家长对机器人辅助腹腔镜肾盂成形术的满意度高于开放手术。有趣的是，满意度的差异并不像预期的那么大，这表明存在年龄和术前父母期望等混杂因素的影响。未来需要使用专门针对小儿外科的验证调查进行大规模前瞻性研究，以进一步阐明微创外科技术（如机器人辅助）的真正益处。
