Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
Department of Urology, Royal Surrey County Hospital, Guildford, UK.
Eur Urol. 2014 Feb;65(2):430-52. doi: 10.1016/j.eururo.2013.06.053. Epub 2013 Jul 4.
Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized.
To critically analyze the current status of laparoscopic and robotic repair of UPJO.
A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria.
Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population.
Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
在过去的二十年中，已经开发并推广了用于治疗肾盂输尿管连接部梗阻（UPJO）的微创治疗选择。
批判性地分析腹腔镜和机器人治疗 UPJO 的现状。
2012 年 11 月，使用 PubMed 进行了系统的文献复习。根据基于系统评价和荟萃分析优先报告项目的搜索策略进行文章选择。
多项腹腔镜肾盂成形术系列研究表明，在儿科和成人人群中，经腹腔和后腹腔入路均具有较高的成功率和较低的围手术期发病率。儿科机器人辅助肾盂成形术的数据也越来越多。也有更多的成人病例报告，证实机器人肾盂成形术是原发性或继发性修复的可行选择。机器人辅助再次肾盂成形术主要在儿科人群中进行了描述。为了使手术适应每个具体病例，已经实施了不同的技术变化。内支架和外支架以及无支架方法已被使用，尤其是在儿科人群中。比较研究表明，微创肾盂成形术与开放肾盂成形术在成人和儿科人群中的成功率和并发症发生率相似。微创肾盂成形术与开放肾盂成形术相比，仅在成人人群中观察到住院时间明显缩短。
腹腔镜代表了一种比开放肾盂成形术更有效和有效的微创替代方法。只要有机器人技术，机器人肾盂成形术可能会成为新的微创治疗标准，因为其精确的缝合和较短的学习曲线是独特的吸引人的特点。对于腹腔镜和机器人技术，根据术中发现和个人手术经验，可以根据具体情况定制手术技术。
