Sforza Simone, Di Maida Fabrizio, Mari Andrea, Zaccaro Claudia, Cini Chiara, Tellini Riccardo, Carini Marco, Minervini Andrea, Masieri Lorenzo
Department of Pediatric Urology, University of Florence, Meyer Hospital, Florence, Italy.
Department of Oncologic, Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy.
J Laparoendosc Adv Surg Tech A. 2019 Sep;29(9):1180-1184. doi: 10.1089/lap.2019.0302. Epub 2019 Jul 29.
To compare the surgical outcomes of children submitted to robot-assisted reconstruction with or without drainage placement performed by a single surgeon in a tertiary referral center. Patients submitted to robot-assisted reconstruction, including pyeloplasty for ureteral pelvic junction obstruction, end-to-end anastomosis for retrocaval ureter, and reimplantation for vesical ureter reflux (VUR) from January 2016 to November 2018, were included. Patients with ureteral pelvic junction obstruction or retrocaval ureter were selected for surgery according to the presence of symptoms and/or evidence of obstruction on diagnostic imaging. The criteria for reimplantation included breakthrough urinary tract infections, progressive renal scarring, and persistent VUR despite watchful waiting. Overall, 31 children composed the no drain placement (DP) group and 29 the DP group. Preoperative feature of the two groups were comparable. Overall, only 1 (3.3%) postoperative complication occurred in no DP group and 2 (6.9%) in the placement group ( = .512). Length of stay was 3 (interquartile range [IQR]: 3-4) and 4 (IQR: 4-4) days, respectively ( = .651). At last follow-up, overall success rate was 100% in the no DP group and 96.6% in the DP group ( = .297). Robot-assisted reconstruction represents a safe minimally invasive approach with optimal surgical outcomes for the treatment of upper urinary tract. Expert robotic surgeons could avoid drainage placement after surgery as this does not undermine perioperative outcomes and postoperative success rate. Our study, first in literature, proves the interest in assessing the safety of no drainage placement also in the pediatric field.
在一家三级转诊中心，比较由同一位外科医生实施的机器人辅助重建手术（无论是否放置引流管）治疗儿童的手术效果。纳入2016年1月至2018年11月期间接受机器人辅助重建手术的患者，包括因输尿管肾盂连接部梗阻而行肾盂成形术、因腔静脉后输尿管而行端端吻合术以及因膀胱输尿管反流（VUR）而行再植术的患者。输尿管肾盂连接部梗阻或腔静脉后输尿管患者根据症状和/或诊断影像上的梗阻证据选择手术。再植术的标准包括反复发生的尿路感染、进行性肾瘢痕形成以及尽管密切观察但仍持续存在的VUR。总体而言，31名儿童组成无引流管放置（DP）组，29名儿童组成引流管放置组。两组的术前特征具有可比性。总体而言，无DP组术后仅发生1例（3.3%）并发症，引流管放置组发生2例（6.9%）并发症（P = 0.512）。住院时间分别为3天（四分位间距[IQR]：3 - 4）和4天（IQR：4 - 4）（P = 0.651）。在最后一次随访时，无DP组的总体成功率为100%，引流管放置组为96.6%（P = 0.297）。机器人辅助重建是一种安全的微创方法，对上尿路疾病的治疗具有最佳手术效果。专业的机器人外科医生可以避免术后放置引流管，因为这不会影响围手术期结果和术后成功率。我们的研究在文献中尚属首次，证明了在儿科领域评估不放置引流管安全性的意义。
