Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
Eur Urol. 2012 Feb;61(2):410-4. doi: 10.1016/j.eururo.2011.10.024. Epub 2011 Oct 24.
Conventional laparoendoscopic single-site (C-LESS) pyeloplasty is technically challenging due to instrument clashing, loss of triangulation, and difficulty sewing. Application of the da Vinci S or Si robotic platforms could potentially overcome these challenges.
Compare our initial experience with robotic assisted laparoendoscopic single-site (R-LESS) pyeloplasty to our latter experience with C-LESS pyeloplasty (ie, after the initial 15 patients).
DESIGN, SETTING, AND PARTICIPANTS: This single-institution retrospective observational cohort study involved consecutive patients who presented with symptomatic ureteropelvic junction obstruction and who were deemed suitable for single-incision pyeloplasty by the treating surgeon.
Demographic, clinical, perioperative, and early postoperative comparative outcomes.
Ten patients each underwent R-LESS or C-LESS pyeloplasty by a single surgeon between March 2009 and July 2011. For R-LESS and C-LESS groups, age, gender distribution, body mass index, proportion of patients with prior abdominal surgery, estimated blood loss, and hospital length of stay were statistically similar. Mean operative time was significantly longer for R-LESS (226 vs 188 min; p=0.007). C-LESS pyeloplasty alone required an accessory port for the anastomosis in 10 of 10 cases. Two conversions to standard laparoscopy and two postoperative complications occurred in 3 of 10 patients in the C-LESS group, compared with no conversions and one postoperative complication in the R-LESS group (p=0.26). Study limitations are a retrospective design, a modest number of patients, and a lack of quantification of subjective outcomes such as instrument clashing and maneuverability.
Adaptation of the da Vinci Si robotic surgical platform to laparoendoscopic single-site pyeloplasty appears to reduce the physical learning curve for this complex procedure. Future prospective, comprehensive evaluation of additional outcomes including subjective parameters, cosmesis, and longer term functional outcomes will help better define its role in minimally invasive dismembered pyeloplasty and better estimate its associated learning curve.
传统的经腹腔镜单部位（C-LESS）肾盂成形术由于器械碰撞、三角丢失和缝合困难而具有技术挑战性。达芬奇 S 或 Si 机器人平台的应用有可能克服这些挑战。
将我们最初的机器人辅助经腹腔镜单部位（R-LESS）肾盂成形术经验与后来的 C-LESS 肾盂成形术经验进行比较（即，在最初的 15 例患者之后）。
设计、设置和参与者：这项单机构回顾性观察队列研究涉及连续就诊的有症状输尿管肾盂交界处梗阻的患者，这些患者由治疗外科医生认为适合单切口肾盂成形术。
人口统计学、临床、围手术期和早期术后比较结果。
2009 年 3 月至 2011 年 7 月期间，同一位外科医生为每位患者分别进行了 R-LESS 或 C-LESS 肾盂成形术。对于 R-LESS 和 C-LESS 组，年龄、性别分布、体重指数、既往腹部手术患者比例、估计失血量和住院时间在统计学上相似。R-LESS 组的手术时间明显更长（226 对 188 分钟；p=0.007）。C-LESS 肾盂成形术仅在 10 例中需要附加吻合端口。C-LESS 组中有 3 例（3/10）患者需要转为标准腹腔镜，2 例患者术后发生并发症，而 R-LESS 组中无转化病例，仅有 1 例术后并发症（p=0.26）。研究的局限性在于回顾性设计、患者数量适中以及缺乏对仪器碰撞和可操作性等主观结果的量化。
达芬奇 Si 机器人手术平台的应用似乎可以减少该复杂手术的物理学习曲线。未来前瞻性、全面评估包括主观参数、美容效果和更长期功能结果在内的其他结果将有助于更好地定义其在微创离断肾盂成形术中的作用，并更好地估计其相关学习曲线。
