Schiavina Riccardo, Zaramella Stefano, Chessa Francesco, Pultrone Cristian Vincenzo, Borghesi Marco, Minervini Andrea, Cocci Andrea, Chindemi Andrea, Antonelli Alessandro, Simeone Claudio, Pagliarulo Vincenzo, Parma Paolo, Samuelli Alessanrdo, Celia Antonio, De Concilio Bernardino, Rocco Bernardo, De Lorenzis Elisa, La Manna Gaetano, Terrone Carlo, Falsaperla Mario, Dente Donato, Porreca Angelo
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy.
J Robot Surg. 2016 Dec;10(4):323-330. doi: 10.1007/s11701-016-0601-0. Epub 2016 May 21.
The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.
输尿管狭窄的治疗颇具挑战，这是由于狭窄的病因、部位及范围存在差异；治疗方法包括端端吻合术，或将其通过Boari瓣或腰大肌悬吊术重新植入膀胱。传统上，这些手术通过开放入路进行，但微创方法已被广泛接受。本研究旨在评估微创手术治疗输尿管狭窄的安全性、可行性及围手术期结果，并进行长期随访。回顾了意大利9个中心62例腹腔镜（n = 36）和机器人辅助（n = 26）治疗输尿管狭窄的数据。根据转诊中心的方案对患者进行随访。比较了腹腔镜和机器人辅助两种手术方式。所有手术均成功完成，无需中转开放手术。两组的平均估计失血量分别为：腹腔镜组91.2±71.9 cc，机器人辅助组47.2±32.3 cc（p = 0.004）。腹腔镜组的平均住院天数为5.9±2.4天，机器人辅助组为7.6±3.4天（p = 0.006）。手术时间和术后并发症方面未发现差异。中位随访27个月后，机器人辅助组出现2例狭窄复发，而腹腔镜组无复发病例（p = 0.091）。输尿管狭窄的微创治疗方法安全可行。机器人辅助和单纯腹腔镜手术在围手术期结果、低并发症发生率和复发率方面均可能取得良好效果。
