Neheman Amos, Kord Eyal, Zisman Amnon, Darawsha Abd Elhalim, Noh Paul H
1 Department of Urology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Zerifin, Israel .
2 Department of Urology, Meir Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Zerifin, Israel .
J Laparoendosc Adv Surg Tech A. 2018 Apr;28(4):467-470. doi: 10.1089/lap.2017.0262. Epub 2017 Dec 5.
To compare outcomes between robotic pyeloplasty (RP) and standard laparoscopic pyeloplasty (LP) in the infant population for the treatment of ureteropelvic junction (UPJ) obstruction.
We performed a retrospective cohort study of all children under 1 year of age who underwent RP or LP at two different medical centers between October 2009 and February 2016. Patient demographics, perioperative data, complications, and results were reviewed.
Thirteen patients underwent standard LP, and 21 patients underwent RP during the study period. Median age and median weight at time of operation for the whole cohort were 6.1 months and 7.9 kg. Surgery success rates were similar with 95% and 92% in RP and LP, respectively. There was no statistically significant difference in operating time between the 2 groups, with a median time of 156 minutes in RP (range 125-249) and 192 minutes (range 98-229) in standard LP (P = .35). Median length of hospital stay was significantly shorter in the robotic group with a median stay of 1 day (range 1-3) and 7 days (range 7-12) in the standard LP group.(P < .0001) Drains or nephrostomy tubes were used more often in the laparoscopic group (100%, 13/13) as opposed to RP (9.5%, 2/21, P < .0001) There was a comparable complication rate between the 2 groups, 30.8% for LP and 23.8% for RP (P = .65).
The minimally invasive dismembered pyeloplasty is safe and effective in the infant population and produces high success rates. The results, complication rates, and operative time were comparable between the two surgical methods while the standard LP demonstrated longer hospital stay. Both the robotic approach and the LP can be successfully utilized for the benefit of infants with UPJ obstruction.
比较机器人肾盂成形术（RP）与标准腹腔镜肾盂成形术（LP）治疗婴儿输尿管肾盂连接部（UPJ）梗阻的疗效。
我们对2009年10月至2016年2月期间在两个不同医疗中心接受RP或LP手术的所有1岁以下儿童进行了一项回顾性队列研究。回顾了患者的人口统计学资料、围手术期数据、并发症及结果。
研究期间，13例患者接受了标准LP手术，21例患者接受了RP手术。整个队列手术时的中位年龄和中位体重分别为6.1个月和7.9千克。RP组和LP组的手术成功率相似，分别为95%和92%。两组手术时间无统计学显著差异，RP组中位时间为156分钟（范围125 - 249分钟），标准LP组为192分钟（范围98 - 229分钟）（P = 0.35）。机器人手术组的中位住院时间明显更短，中位住院时间为1天（范围1 - 3天），标准LP组为7天（范围7 - 12天）（P < 0.0001）。腹腔镜组更常使用引流管或肾造瘘管（100%，13/13），而RP组为9.5%（2/21，P < 0.0001）。两组并发症发生率相当，LP组为30.8%，RP组为23.8%（P = 0.65）。
微创离断性肾盂成形术在婴儿人群中安全有效，成功率高。两种手术方法的结果、并发症发生率和手术时间相当，但标准LP显示住院时间更长。机器人手术方法和LP都可成功用于治疗UPJ梗阻的婴儿。
