Castagnetti Marco, Iafrate Massimo, Esposito Ciro, Subramaniam Ramnath
Section of Paediatric Urology, Department of Surgical, Oncological, and Gastrointestinal Sciences, University Hospital of Padova, Padua, Italy.
Department of Paediatrics, Federico II University of Naples, Naples, Italy.
Front Pediatr. 2020 Jun 2;8:252. doi: 10.3389/fped.2020.00252. eCollection 2020.
To review the published evidence on the minimally invasive pyeloplasty techniques available currently with particular emphasis on the comparative data about the various minimally invasive alternatives to treat pelvi-ureteric junction obstruction and gauge if one should be favored under certain circumstances. Non-systematic review of literature on open and minimally invasive pyeloplasty including various kinds of laparoscopic procedures, the robotic-assisted laparoscopic pyeloplasty, and endourological procedures. Any particular minimally invasive pyeloplasty procedure seems feasible in experienced hands, irrespective of age including infants. Comparative data suggest that the robotic-assisted procedure has gained wider acceptance mainly because it is ergonomically more suited to surgeon well-being and facilitates advanced skills with dexterity thanks to 7 degrees of freedom. However, costs remain the major drawback of robotic surgery. In young children and infants, instead, open surgery can be performed via a relatively small incision and quicker time frame. The best approach for pyeloplasty is still a matter of debate. The robotic approach has gained increasing acceptance over the last years with major advantages of the surgeon well-being and ergonomics and the ease of suturing. Evidence, however, may favor the use of open surgery in infancy.
回顾目前可用的微创肾盂成形术技术的已发表证据，特别强调关于治疗肾盂输尿管连接部梗阻的各种微创替代方法的比较数据，并判断在某些情况下是否应优先选择某一种方法。对开放和微创肾盂成形术的文献进行非系统综述，包括各种腹腔镜手术、机器人辅助腹腔镜肾盂成形术和腔内泌尿外科手术。任何一种特定的微创肾盂成形术在经验丰富的医生手中似乎都是可行的，无论患者年龄大小，包括婴儿。比较数据表明，机器人辅助手术得到了更广泛的认可，主要是因为它在人体工程学上更适合医生操作，并且由于具有7个自由度，有助于灵活施展高级技能。然而，成本仍然是机器人手术的主要缺点。相反，对于幼儿和婴儿，可以通过相对较小的切口和更短的时间进行开放手术。肾盂成形术的最佳方法仍存在争议。在过去几年中，机器人手术方法越来越被接受，其主要优点是有利于医生操作和符合人体工程学，且缝合容易。然而，证据可能支持在婴儿期使用开放手术。
