Reinhardt Susanne, Ifaoui Inge Boetker, Thorup Jorgen
a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark.
b Faculty of Medical and Health Sciences , University of Copenhagen , Copenhagen , Denmark.
Scand J Urol. 2017 Aug;51(4):335-338. doi: 10.1080/21681805.2017.1302990. Epub 2017 Apr 11.
Owing to the encouraging data on fellowship training in robotic pyeloplasty and the documented benefits of robotic pyeloplasty, the aim of this study was to test the feasibility of starting up pediatric urological robotic surgery in a center with a limited case volume.
The operative parameters and clinical outcome of the first 25 robotic pyeloplasties performed were compared to data on open and laparoscopic procedures from the previous 5 year period. The fellow was the only console surgeon. An experienced non-robotic pediatric urologist was supervising at the patient site.
The learning curve was in accordance with previously published data on fellows. The median operating time in robotic surgery was 182 min and was significantly shorter than in laparoscopic surgery (median 250 min) and the postoperative inpatient length of stay was significantly shorter after robotic surgery (median 1 day) than after both laparoscopic (median 2 days) and open surgery (median 3.5 days). For robotic cases, postoperative renography showed either stable or increased function of the hydronephrotic kidney. The only complication was in one case with ureteral orifice edema after JJ-stent removal, requiring nephrostomy for 6 weeks.
The benefits of overall shorter postoperative hospital stay after robotic pyeloplasty and faster operating time compared to the laparoscopic procedure are clearly in accordance with data from the recent literature. The fast learning curve for robotic pyeloplasty will allow pediatric urology fellowship programs to be integrated in the start-up phase of a pediatric robotic program even though the case material is limited. Operative success rates were in accordance with the gold standard of open surgery.
鉴于机器人肾盂成形术进修培训方面令人鼓舞的数据以及机器人肾盂成形术已被证实的益处，本研究旨在测试在病例数量有限的中心开展小儿泌尿外科机器人手术的可行性。
将所施行的前25例机器人肾盂成形术的手术参数及临床结果与过去5年期间开放性手术和腹腔镜手术的数据进行比较。进修医生是唯一的控制台手术医生。一名经验丰富的非机器人小儿泌尿外科医生在患者手术现场进行监督。
学习曲线与先前发表的关于进修医生的资料一致。机器人手术的中位手术时间为182分钟，明显短于腹腔镜手术（中位时间250分钟），且机器人手术后的术后住院时间（中位时间1天）明显短于腹腔镜手术（中位时间2天）和开放性手术（中位时间3.5天）。对于机器人手术病例，术后肾图显示肾积水肾脏功能稳定或增强。唯一的并发症是1例在拔除双J管后出现输尿管口水肿，需要进行6周的肾造瘘术。
与腹腔镜手术相比，机器人肾盂成形术后总体术后住院时间更短且手术时间更快，这一益处显然与近期文献数据相符。尽管病例数量有限，但机器人肾盂成形术快速的学习曲线将使小儿泌尿外科进修培训项目能够在小儿机器人项目的启动阶段得以整合。手术成功率与开放性手术这一金标准相符。
