Stern Noah, Wang Peter, Dave Sumit
London Health Sciences Centre, Western University, London, ON, Canada.
Can Urol Assoc J. 2021 Apr;15(4):E215-E220. doi: 10.5489/cuaj.6604.
Robotic pediatric urologic surgery has gained wide-spread adoption over the last decade. This article describes our experience in instituting the first pediatric urologic robotic surgery program in Canada. We evaluated the feasibility and safety of instituting pediatric robot-assisted urologic surgery and report our early outcomes for robot-assisted pyeloplasty (RAP) and ureteric reimplantation (RUR).
We prospectively evaluated all patients undergoing RAP and RUR by a single surgeon from June 2013 to March 2019. Demographic and clinical data were prospectively collected and included sex, age, and preoperative grade of hydronephrosis or reflux. Descriptive statistics were performed, and comparisons were made using Student's t-tests where appropriate. Success was defined as resolution or significant improvement of hydronephrosis following RAP and absence of recurrent urinary tract infection (UTI) and/or persistent vesicoureteric reflux (VUR) following RUR. Complications were described using the Clavien-Dindo system.
A total of 52 RAPs and 24 RURs were performed with a minimum of six months followup. Forty-five RAP patients met criteria for success, while diagnostic imaging of success in the form of MAG-3 Lasix renograms was documented in the remaining seven for an overall success of 100%. Sixteen RUR patients met criteria for success and seven showed resolution of VUR on imaging following their first UTI, for an overall success rate of 96%. Operative times progressively improved from 204±35 minutes to 121±15 minutes in the RAP group and from 224±52 to 132±39 minutes in the RUR group. In the RAP cohort, one Clavien grade II and four Clavien grade III complications were noted, while three Clavien grade III complications were noted in the RUR cohort.
Despite limited case volumes, robotic pediatric urologic surgery can be integrated into the Canadian healthcare system with success rates comparable to reported literature. However, compared to open surgery, RAP, and especially RUR, warrant further study to ensure lack of significant complications noted in our study.
在过去十年中，小儿泌尿外科机器人手术已得到广泛应用。本文描述了我们在加拿大开展首个小儿泌尿外科机器人手术项目的经验。我们评估了开展小儿机器人辅助泌尿外科手术的可行性和安全性，并报告了机器人辅助肾盂成形术（RAP）和输尿管再植术（RUR）的早期结果。
我们前瞻性地评估了2013年6月至2019年3月期间由单一外科医生进行RAP和RUR手术的所有患者。前瞻性收集人口统计学和临床数据，包括性别、年龄以及术前肾积水或反流分级。进行描述性统计，并在适当情况下使用学生t检验进行比较。成功定义为RAP术后肾积水消退或显著改善，以及RUR术后无复发性尿路感染（UTI）和/或持续性膀胱输尿管反流（VUR）。使用Clavien-Dindo系统描述并发症。
共进行了52例RAP手术和24例RUR手术，随访时间至少为6个月。45例RAP患者达到成功标准，其余7例通过MAG-3速尿肾图形式的成功诊断成像记录，总体成功率为100%。16例RUR患者达到成功标准，7例在首次UTI后的成像中显示VUR消退，总体成功率为96%。RAP组的手术时间从204±35分钟逐步改善至121±15分钟，RUR组从224±52分钟改善至132±39分钟。在RAP队列中，记录到1例Clavien II级和4例Clavien III级并发症，而在RUR队列中记录到3例Clavien III级并发症。
尽管病例数量有限，但小儿泌尿外科机器人手术可以成功整合到加拿大医疗保健系统中，成功率与已发表文献相当。然而，与开放手术相比，RAP，尤其是RUR，需要进一步研究以确保我们研究中未发现重大并发症。
