Blanc Thomas, Kohaut Jules, Elie Caroline, Clermidi Pauline, Pio Luca, Harte Caroline, Brönnimann Enrico, Botto Nathalie, Rousseau Véronique, Sonigo Pascale, Vaessen Christophe, Lottmann Henri, Aigrain Yves
Service de Chirurgie Viscérale et Urologie Pédiatriques, APHP, Hôpital Necker, Paris, France.
Université Sorbonne Paris Cité, Paris, France.
Front Pediatr. 2019 May 28;7:209. doi: 10.3389/fped.2019.00209. eCollection 2019.
Robot-assisted laparoscopic pyeloplasty (RALP) is gaining acceptance among pediatric urologists. Few studies have evaluated the retroperitoneal approach for RALP. We share our experience from the first 2 years of a multidisciplinary pediatric robotic program in our center. We performed a retrospective analysis of prospectively collected data of children undergoing RALP for ureteropelvic junction obstruction ( = 50). Diagnosis was confirmed by ultrasound and Tc-99m mercaptoacetyltriglycine renal scan or MRI; the same criteria were used to evaluate outcome. Surgical approach was chosen according to a specific algorithm. Transperitoneal approach ( = 13) was reserved for horseshoe kidney, ectopic kidney, and redo surgery. We analyzed the 37 cases performed by a lateral retroperitoneal approach. Dismembered pyeloplasty was done for all cases and anastomosis was performed using a running monofilament 6/0 absorbable suture. All were drained by double J stent. Patient data, operating room parameters and postoperative course were recorded. The median age was 7.9 years (5.1-13.8); the youngest was 2 years old. The median weight was 23 kg (17-41) with the smallest weighing 12.4 kg. Aberrant crossing vessels were present in 18 children. Median set-up time, from skin incision until the end of the 4-port insertion, was 33 min (29-48). Median surgeon's console time was 151 min (136-182). No conversion to an open procedure was necessary. The postoperative course was free of complications, except urinary tract infection in 6 children. All but 4 patients were discharged on day one. Median follow-up was 9 months (5-13). Redo pyeloplasty was not required. Practical training of other colleagues was possible after 10 cases performed by the same surgeon. These preliminary results suggest that retroperitoneal RALP in children is feasible, safe and effective. It is an excellent option with ideal anatomical exposure. Longer term results as well as continued practice will identify and overcome any challenges and enable surgical mastery of this procedure which is still evolving.
机器人辅助腹腔镜肾盂成形术（RALP）在儿科泌尿外科医生中越来越受到认可。很少有研究评估RALP的腹膜后入路。我们分享了我们中心多学科儿科机器人项目头两年的经验。我们对前瞻性收集的50例因肾盂输尿管连接部梗阻接受RALP手术的儿童数据进行了回顾性分析。通过超声、Tc-99m巯基乙酰三甘氨酸肾扫描或MRI确诊；采用相同标准评估手术效果。根据特定算法选择手术入路。经腹入路（13例）适用于马蹄肾、异位肾和再次手术。我们分析了37例采用侧腹膜后入路的病例。所有病例均行离断性肾盂成形术，使用连续单丝6/0可吸收缝线进行吻合。均留置双J支架引流。记录患者数据、手术室参数和术后病程。中位年龄为7.9岁（5.1 - 13.8岁）；最小年龄为2岁。中位体重为23千克（17 - 41千克），最轻体重为12.4千克。18例患儿存在迷走血管。从皮肤切口至四孔置入结束的中位建立时间为33分钟（29 - 48分钟）。中位术者控制台操作时间为151分钟（136 - 182分钟）。无需转为开放手术。术后病程无并发症，仅6例患儿发生尿路感染。除4例患者外，所有患者均于术后第一天出院。中位随访时间为9个月（5 - 13个月）。无需再次肾盂成形术。同一位外科医生完成10例手术后，可为其他同事提供实践培训。这些初步结果表明，儿童腹膜后RALP是可行、安全且有效的。它是一种具有理想解剖暴露的极佳选择。长期结果以及持续实践将识别并克服任何挑战，实现对这一仍在发展的手术的熟练掌握。
