Hemal Ashok K, Mukherjee Satyadip, Singh Kaku
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Can J Urol. 2010 Feb;17(1):5012-6.
To compare operative parameters and outcomes in 30 cases of robotic pyeloplasty (RP) versus 30 cases of laparoscopic pyeloplasty (LP), performed by a single surgeon, for ureteropelvic junction (UPJ) obstruction.
Patients with primary UPJ obstruction were included in the study. The same surgeon (AKH) performed RP (usually using a transperitoneal Anderson-Hynes technique) on 30 patients in Group I and employed LP on 30 patients in Group II, in a nonrandomized fashion. The patients were followed for 18 months postoperatively. Three robotic and one assistant port were required in Group I, and 3 or 4 ports were utilized in Group II. In Group I, 26 patients had antegrade double-J stenting, 1 patient had retrograde double-J stenting, and 3 patients had stentless RP. In Group II, 22 patients had antegrade double-J stenting and 8 patients had retrograde double-J stenting.
The mean total operating times were 98 minutes and 145 minutes, the mean estimated blood losses were 40 mL and 101 mL, and the mean hospital stays of the patients were 2 days and 3.5 days, for patients in Group I and Group II, respectively. These patients were followed up postoperatively for 18 months. They received a clinical examination, an ultrasound, and a diuretic renal dynamic scan. At 18 months, imaging studies found no obstructions in the patients in Group I and found an obstruction in only one patient in Group II. One patient in Group II required a repeat open pyeloplasty following failed endoscopic management.
In this patient series, UPJ obstruction was managed effectively with either RP or LP, and outcomes were durable. Compared to pure LP, pure RP enabled the surgeon to achieve quicker dissection, reconstruction, and intracorporeal suturing with fine sutures and with antegrade double-J stenting. With RP, the operating time was decreased, and the procedure offered greater ergonomic convenience to the surgeon. Long term postoperative success, however, was equivalent on follow up in both patient groups.
比较由同一位外科医生进行的30例机器人肾盂成形术（RP）与30例腹腔镜肾盂成形术（LP）治疗输尿管肾盂连接部（UPJ）梗阻的手术参数和结果。
纳入原发性UPJ梗阻患者进行研究。同一位外科医生（AKH）以非随机方式对第一组30例患者实施RP（通常采用经腹Anderson-Hynes技术），对第二组30例患者实施LP。术后对患者进行18个月的随访。第一组需要3个机器人操作孔和1个辅助孔，第二组使用3或4个孔。在第一组中，26例患者进行了顺行双J管置入，1例患者进行了逆行双J管置入，3例患者进行了无支架RP。在第二组中，22例患者进行了顺行双J管置入，8例患者进行了逆行双J管置入。
第一组和第二组患者的平均总手术时间分别为98分钟和145分钟，平均估计失血量分别为40毫升和101毫升，平均住院时间分别为2天和3.5天。这些患者术后随访18个月。他们接受了临床检查、超声检查和利尿肾动态扫描。在18个月时，影像学研究发现第一组患者无梗阻，第二组仅1例患者有梗阻。第二组有1例患者在内镜治疗失败后需要再次进行开放性肾盂成形术。
在该患者系列中，RP或LP均可有效治疗UPJ梗阻，且效果持久。与单纯LP相比，单纯RP使外科医生能够更快地进行解剖、重建和体内缝合，使用精细缝线并进行顺行双J管置入。使用RP可缩短手术时间，且该手术为外科医生提供了更大的人体工程学便利性。然而，两组患者随访时的长期术后成功率相当。
