Department of Surgery, Division of Urology, University of Chicago School of Medicine and Biological Sciences, and Comer Children's Hospital, Chicago, Illinois.
J Urol. 2013 Dec;190(6):2221-6. doi: 10.1016/j.juro.2013.07.063. Epub 2013 Aug 1.
Robotic surgery has evolved from simple extirpative surgery to complex reconstructions even in infants. Data are lacking comparing surgical and direct costs to open approaches. We describe the feasibility, salient tips and outcomes of robot-assisted laparoscopic pyeloplasty compared to an open approach.
We evaluated patients undergoing open pyeloplasty or robot-assisted laparoscopic pyeloplasty. Ten patients in each group met inclusion criteria.
Mean patient age was 3.31 months in the open group and 7.3 months in the robotic group (p=0.02). Postoperative outcomes including length of stay (2.2 vs 2.1 days), estimated blood loss (6.5 vs 7.6 ml), days to regular diet (1 vs 1.1) and days to Foley catheter removal (1.3 vs 1.3) were similar between the open and robotic groups. Total operating time (199 vs 242 minutes) was significantly longer in the robotic group. Postoperative improvement in hydronephrosis was identical in both groups. Direct costs, excluding amortization, robotic cost, maintenance and depreciation, were $4,410 in the open group and $4,979 in the robotic group (p=0.10).
In our preliminary experience robotic pyeloplasty in infants is feasible and safe. The immediate outcomes are similar to those of an open approach. The robotic technique in infants currently has the benefits of improved esthetic appearance, improved pain control and similar direct costs compared to the traditional open approach.
机器人手术已经从简单的切除术发展到即使在婴儿中也能进行复杂的重建术。缺乏比较开放手术的手术和直接成本的数据。我们描述了机器人辅助腹腔镜肾盂成形术与开放手术相比的可行性、显著技巧和结果。
我们评估了接受开放肾盂成形术或机器人辅助腹腔镜肾盂成形术的患者。每组各有 10 名符合纳入标准的患者。
开放组患者的平均年龄为 3.31 个月，机器人组为 7.3 个月（p=0.02）。术后结果包括住院时间（2.2 天 vs 2.1 天）、估计失血量（6.5 毫升 vs 7.6 毫升）、恢复正常饮食的天数（1 天 vs 1.1 天）和拔除 Foley 导管的天数（1.3 天 vs 1.3 天）在开放组和机器人组之间相似。机器人组的总手术时间（199 分钟 vs 242 分钟）明显更长。两组术后肾积水改善情况相同。不包括摊销、机器人成本、维护和折旧的直接成本，开放组为 4410 美元，机器人组为 4979 美元（p=0.10）。
在我们的初步经验中，婴儿机器人肾盂成形术是可行和安全的。即时结果与开放手术相似。与传统的开放手术相比，目前机器人技术在婴儿中具有改善美观、改善疼痛控制和相似直接成本的优点。
