Schomburg John L, Haberman Ken, Willihnganz-Lawson Katie H, Shukla Aseem R
Section of Pediatric Urology, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN, USA.
Section of Pediatric Urology, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN, USA.
J Pediatr Urol. 2014 Oct;10(5):875-9. doi: 10.1016/j.jpurol.2014.02.013. Epub 2014 Apr 4.
The aim was to report a single surgeon's experience comparing open and robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) to treat vesicoureteral reflux (VUR).
We retrospectively reviewed the outcomes of RALUR and open extravesical ureteral reimplantations consecutively performed by a single surgeon between January 2008 and December 2010 using the da Vinci(®) Surgical System. Both groups of patients were subjected to identical pre- and postoperative care protocols.
During the defined study interval, 20 open and 20 RALUR procedures were completed by a single surgeon at our institution. Gender and VUR grade were similar in both cohorts. Operative times were longer in the RALUR group, but postoperative opioid use (morphine equivalents) was significantly lower in the RALUR group (RALUR: 0.14 mg/kg, open: 0.25 mg/kg, p = 0.021). There was no significant difference in estimated blood loss (EBL) or length of hospitalization (LOH). The overall rate of surgical complications was similar; however, the complications in the open group tended to be less severe than those occurring in the RALUR group. On follow-up, after a median of 52 months for open surgery and 39 months for RALUR, two children had developed a febrile urinary tract infection in both groups, of which one in the open group had persistent VUR.
This single-surgeon experience of open and initial experience with RALUR performed with the same surgical technique on consecutive cohorts with identical post-surgical care protocol allows a comparative analysis of outcomes for a surgeon transitioning to RALUR. The RALUR reduces postoperative analgesic requirements while yielding similar clinical outcomes as the open technique.
报告一位外科医生比较开放手术和机器人辅助腹腔镜膀胱外输尿管再植术（RALUR）治疗膀胱输尿管反流（VUR）的经验。
我们回顾性分析了2008年1月至2010年12月间同一位外科医生连续进行的RALUR和开放膀胱外输尿管再植术的结果，手术使用达芬奇（®）手术系统。两组患者均接受相同的术前和术后护理方案。
在规定的研究期间，我们机构的一位外科医生完成了20例开放手术和20例RALUR手术。两组患者的性别和VUR分级相似。RALUR组的手术时间较长，但RALUR组术后阿片类药物使用量（吗啡当量）显著低于开放手术组（RALUR：0.14mg/kg，开放手术：0.25mg/kg，p = 0.021）。估计失血量（EBL）和住院时间（LOH）无显著差异。手术并发症的总体发生率相似；然而，开放手术组的并发症往往比RALUR组的并发症轻。随访时，开放手术组中位随访52个月，RALUR组中位随访39个月，两组均有2名儿童发生发热性尿路感染，其中开放手术组有1名儿童存在持续性VUR。
这位外科医生在连续队列中采用相同手术技术并遵循相同术后护理方案进行开放手术的经验以及首次进行RALUR的经验，使得对向RALUR过渡的外科医生的手术结果进行比较分析成为可能。RALUR减少了术后镇痛需求，同时产生了与开放手术技术相似的临床结果。
