Tam Yuk Him, Pang Kristine Kit Yi, Wong Yuen Shan, Chan Kin Wai, Lee Kim Hung
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China .
J Laparoendosc Adv Surg Tech A. 2018 Aug;28(8):1012-1018. doi: 10.1089/lap.2017.0561. Epub 2018 Mar 13.
Robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) are both minimally invasive surgical options to correct ureteropelvic junction obstruction in children. There are limited data reporting surgeons' experience of switching from LP to RALP and comparing the outcomes of the two procedures.
We conducted a retrospective study on 63 consecutive children who underwent either LP or RALP by the same surgeon in a tertiary center from January 2008 to November 2016. LP had been the standard practice until January 2014 when it was replaced by RALP in short transition.
Thirty-seven LP and 26 RALP were successfully performed in children aged 2 months to 16 years. There was no difference between the two groups in age, body weight, laterality, clinical presentations, preoperative imagings, primary/reoperative repairs. The overall success rates were 34/37 (91.9%) and 25/26 (96.2%) for LP and RALP, respectively (P > .05). RALP was associated with shorter length of stay (3.1 days versus 4.0 days; P = .03). Surgeon-in-training participation was greater in RALP group (P < .001). There was no difference in operative time, complication rates, and analgesic requirement between the two groups.
Surgeons proficient in LP can adapt quickly to RALP, achieving comparable outcomes. Robotic technology may facilitate training on minimally invasive pyeloplasty.
机器人辅助腹腔镜肾盂成形术（RALP）和腹腔镜肾盂成形术（LP）都是用于矫正儿童输尿管肾盂连接部梗阻的微创手术选择。关于外科医生从LP转换为RALP的经验以及比较这两种手术效果的数据有限。
我们对2008年1月至2016年11月在一家三级中心由同一位外科医生进行LP或RALP手术的63例连续儿童进行了回顾性研究。直到2014年1月，LP一直是标准术式，之后在短暂过渡期间被RALP取代。
在2个月至16岁的儿童中成功进行了37例LP和26例RALP手术。两组在年龄、体重、患侧、临床表现、术前影像学检查、初次/再次手术修复方面无差异。LP和RALP的总体成功率分别为34/37（91.9%）和25/26（96.2%）（P＞0.05）。RALP与住院时间缩短相关（3.1天对4.0天；P = 0.03）。RALP组中接受培训的外科医生参与度更高（P＜0.001）。两组在手术时间、并发症发生率和镇痛需求方面无差异。
精通LP的外科医生可以快速适应RALP，取得相当的手术效果。机器人技术可能有助于微创肾盂成形术的培训。
