Silay M S, Spinoit A F, Undre S, Fiala V, Tandogdu Z, Garmanova T, Guttilla A, Sancaktutar A A, Haid B, Waldert M, Goyal A, Serefoglu E C, Baldassarre E, Manzoni G, Radford A, Subramaniam R, Cherian A, Hoebeke P, Jacobs M, Rocco B, Yuriy R, Zattoni Fabio, Kocvara R, Koh C J
Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey; Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Department of Urology, Ghent University Hospital, Ghent, Belgium.
J Pediatr Urol. 2016 Aug;12(4):229.e1-7. doi: 10.1016/j.jpurol.2016.04.007. Epub 2016 May 12.
Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP).
The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP.
A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb.
This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder.
Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.
在过去十年中，小儿肾盂输尿管连接部（UPJ）梗阻的微创肾盂成形术（MIP）作为开放手术的替代方法越来越受欢迎。本研究旨在确定影响小儿MIP并发症发生率的因素，并比较腹腔镜肾盂成形术（LP）和机器人辅助腹腔镜肾盂成形术（RALP）的治疗效果。
回顾性评估了15个学术中心783例年龄小于18岁、接受LP或RALP联合Anderson Hynes离断性肾盂成形术的儿科患者的围手术期数据。排除再次手术病例和有解剖学肾脏异常的患者。收集人口统计学和手术数据，包括手术相关因素。并发症根据Satava和改良Clavien系统进行分类。失败定义为以下任何一种情况：利尿肾动态显像的梗阻参数、肾功能下降、进行性肾积水或症状复发。采用单因素和多因素分析确定影响并发症发生率的因素。对LP和RALP的所有参数进行比较。
共有575名儿童符合纳入标准。单因素分析显示，腹腔镜手术、手术时间延长、住院时间延长、输尿管支架置入技术以及支架置入所需时间是影响并发症发生率的因素。多因素分析中，这些因素均无显著意义。RALP的平均随访时间为12.8±9.8个月，LP为45.2±33.8个月（P = 0.001）。机器人肾盂成形术的住院时间和支架置入时间较短（两者P均<0.05）。RALP和LP的成功率相似（分别为99.5%和97.3%，P = 0.11）。RALP和LP的术中并发症发生率相当（分别为3.8%和7.4%，P = 0.06）。然而，LP组的术后并发症发生率显著更高（RALP为3.2%，LP为7.7%，P = 0.02）。所有并发症的严重程度均不超过Satava IIa级和Clavien IIIb级。
这是儿科人群中最大的LP和RALP多中心系列研究。本研究的局限性包括回顾性设计以及缺乏作为混杂因素的手术经验。
在全球许多中心，所研究的两种微创方法在治疗小儿UPJ梗阻方面均安全且高效。然而，RALP的住院时间更短，术后并发症发生率更低。本研究的目的得以实现。
