Gundeti Mohan S, Petravick Michael E, Pariser Joseph J, Pearce Shane M, Anderson Blake B, Grimsby Gwen M, Akhavan Ardavan, Dangle Pankaj P, Shukla Aseem R, Lendvay Thomas S, Cannon Glenn M, Gargollo Patricio C
Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA.
Comer Children's Hospital, University of Chicago Medicine, Chicago, IL, USA.
J Pediatr Urol. 2016 Dec;12(6):386.e1-386.e5. doi: 10.1016/j.jpurol.2016.05.031. Epub 2016 Jun 15.
Robotic techniques are increasingly being used for reconstructive procedures in the pediatric population.
The present study reported the functional and perioperative outcomes of a multi-institutional cohort of pediatric patients who underwent robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy (RALMA).
Pediatric patients who underwent RALMA at five different centers were included. Positioning is shown (Summary Figure). Demographics were gathered, and intraoperative parameters included concomitant procedures, detrusor tunnel length, estimated blood loss (EBL) and operative time. Perioperative outcomes included length of hospital stay (LOS), morphine use and 30-day complications. Outcomes were reported in terms of stomal continence and surgical revisions.
Eighty-eight patients with a mean age of 10.4 ± 4.0 years were included in the analysis. Median follow-up was 29.5 months (IQR 11.8-45.0). Bladder augmentation was performed concomitantly in 15 (17%) patients, and bladder neck procedures in 34 (39%). Mean detrusor tunnel length was 3.9 ± 1.0 cm, EBL was 54 ± 70 ml, and operative time was 424 ± 120 min. Postoperatively, mean LOS was 5.2 ± 2.8 days. Patients who underwent concomitant augmentation had higher EBL and operative times (both P < 0.05). At 90 days, complications occurred in 26 patients (29.5%) with six Clavien grade ≥3 (6.8%). During follow-up, 11 (12.5%) patients required appendicovesicostomy revision. Regarding functional outcomes, 75 (85.2%) patients were initially continent. After additional procedures, 81 (92.0%) patients were continent at last follow-up.
Compared to previous open series, initial stomal continence rates with RALMA were acceptable, with a minority of patients requiring subsequent procedures to manage complications and achieve continence.
RALMA is safe and effective in a pediatric population with regard to perioperative complications and stomal continence.
机器人技术越来越多地用于儿科患者的重建手术。
本研究报告了接受机器人辅助腹腔镜米氏阑尾膀胱造口术（RALMA）的多机构儿科患者队列的功能和围手术期结果。
纳入在五个不同中心接受RALMA手术的儿科患者。展示了手术体位（总结图）。收集了人口统计学数据，术中参数包括同期手术、逼尿肌隧道长度、估计失血量（EBL）和手术时间。围手术期结果包括住院时间（LOS）、吗啡使用情况和30天并发症。结果以造口控尿和手术翻修情况报告。
88例平均年龄为10.4±4.0岁的患者纳入分析。中位随访时间为29.5个月（四分位间距11.8 - 45.0）。15例（17%）患者同期进行了膀胱扩大术，34例（39%）患者进行了膀胱颈手术。平均逼尿肌隧道长度为3.9±1.0cm，EBL为54±70ml，手术时间为424±120分钟。术后，平均住院时间为5.2±2.8天。同期进行膀胱扩大术的患者EBL和手术时间更高（均P<0.05）。90天时，26例患者（29.5%）出现并发症，其中6例Clavien分级≥3级（6.8%）。随访期间，11例（12.5%）患者需要进行阑尾膀胱造口术翻修。关于功能结果，75例（85.2%）患者最初控尿良好。经过额外手术后，81例（92.0%）患者在最后随访时控尿良好。
与先前的开放手术系列相比，RALMA的初始造口控尿率可以接受，少数患者需要后续手术来处理并发症并实现控尿。
就围手术期并发症和造口控尿而言，RALMA在儿科患者中是安全有效的。
