Junejo Noor Nabi, Alotaibi Anwar, Alshahrani Saeed Malwi, Alshammari Ahmad, Peters Craig A, Alhazmi Hamdan, Vallasciani Santiago A
Urology Department, King Faisal Specialist Hospital and Research Centre and College of Medicine, Alfaisal University, Abha, Saudi Arabia.
Pediatric Urology Division, Urology Department, King Faisal Specialist Hospital and Research Centre, Abha, Saudi Arabia.
Urol Ann. 2020 Jan-Mar;12(1):19-24. doi: 10.4103/UA.UA_113_19. Epub 2019 Dec 23.
Robotic-assisted pyeloplasty surgery has become the preferred approach of ureteropelvic junction obstruction (UPJO) in pediatrics. However, to our knowledge, there is limited data on the learning curve for robotic-assisted pyeloplasty in children and no similar study from Saudi Arabia.
The objective of the study was to evaluate the progression of the surgical team performing robotic-assisted laparoscopic pyeloplasty (RALP) and to assess the feasibility of the RALP in children, since it is having been recently started in the Kingdom.
Retrospective charts and surgical videos review at the tertiary care centre.
After approval from the internal review board (IRB), we reviewed the surgical video recording of the RALP procedure of 15 patients presented with UPJO from January 2016 to October 2017. Statistical analysis was done for the variables includes dissection time, pyelotomy, anastomosis on both sides, and total surgery time and calculated in minutes. Renal ultrasound reviewed to assess any change in grade.
Fifteen patients with UPJO underwent RALP. Of 15 cases, nine were primary and six cases as secondary UPJO. The median age was 8 (3-15) years. Out of 15 cases, 13 and 2 patients diagnosed as Society for Fetal Urology grades of 4 and 3, respectively. Total operative time was prolonged in secondary group as compared to primary pyeloplasty group (mean [standard deviation (SD)]: 166.3 [35.1], range: 125-223, = 0.0028 versus mean (SD): 149.17 (30.4), range: (114-207, = 0.0008). The success rate was 100% in primary and 84% in secondary cases. The median length of follow-up was 12.0 (7.0-18.0) and 10.0 (8.0-12.5) months in primary and secondary cases, respectively. The overall complication rate was 13% (2/15) (Clavien grade: 1-2).
The evaluation of the learning curve of RALP for this group of patients concluded that total operative time for RALP, performed by the pediatric urology team, steadily decreased with collective surgical experience.
机器人辅助肾盂成形术已成为小儿输尿管肾盂连接部梗阻（UPJO）的首选治疗方法。然而，据我们所知，关于儿童机器人辅助肾盂成形术学习曲线的数据有限，沙特阿拉伯也没有类似的研究。
本研究的目的是评估实施机器人辅助腹腔镜肾盂成形术（RALP）的手术团队的进展情况，并评估RALP在儿童中的可行性，因为该国最近才开始开展该手术。
在三级医疗中心进行回顾性病历和手术视频审查。
经内部审查委员会（IRB）批准后，我们回顾了2016年1月至2017年10月期间15例因UPJO接受RALP手术患者的手术视频记录。对包括解剖时间、肾盂切开术、双侧吻合术和总手术时间在内的变量进行统计分析，以分钟为单位计算。通过肾脏超声检查评估分级的任何变化。
15例UPJO患者接受了RALP手术。15例中，9例为原发性，6例为继发性UPJO。中位年龄为8（3 - 15）岁。15例中，分别有13例和2例被诊断为胎儿泌尿外科学会4级和3级。与原发性肾盂成形术组相比，继发性组的总手术时间延长（平均值[标准差（SD）]：166.3 [35.1]，范围：125 - 223，P = 0.0028；而平均值（SD）：149.17（30.4），范围：（114 - 207），P = 0.0008）。原发性病例的成功率为100%，继发性病例为84%。原发性和继发性病例的中位随访时间分别为12.0（7.0 - 18.0）个月和10.0（8.0 - 12.5）个月。总体并发症发生率为13%（2/15）（Clavien分级：1 - 2级）。
对该组患者RALP学习曲线的评估得出结论，小儿泌尿外科团队实施的RALP总手术时间随着集体手术经验的增加而稳步下降。
Zotero 插件
