Beksac Alp Tuna, Wilson Clark A, Lenfant Louis, Kim Soodong, Aminsharifi Alireza, Zeinab Mahmoud Abou, Kaouk Jihad
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Urology. 2022 Feb;160:130-135. doi: 10.1016/j.urology.2021.10.013. Epub 2021 Oct 26.
To analyze the feasibility of a same day discharge protocol following single-port (SP) robotic pyeloplasty.
From a single institution series, 23 patients (12 multi-port, 11 SP) who underwent primary robotic dismembered pyeloplasty between February 2018 and March 2021 were analyzed. The association between baseline and perioperative characteristics with functional outcome was analyzed using, chi-square, Fisher's exact, Mann Whitney U and t tests.
All SP cases were completed using the mini Pfannenstiel incision without the need for conversion or additional ports. Baseline characteristics were comparable. No intraoperative complications were seen. Only 1 patient in the SP group had a Clavien II complication. All patients in the multi-port group had a drain placed, whereas drain was not placed in the SP group. Length of stay was shorter in the SP group (11.4 vs 42.6 hours, P <.001). Although visual analog pain score was comparable at discharge (P = .633), the SP group had lower opioid usage (morphine milligram equivalent) in the hospital (P <.001) and a lower rate of opioid prescription during discharge (18.2% vs 91.7% P <.001). At a median follow-up of 8 months, no patients had flank pain and all patients had good kidney drainage on follow-up images.
Single-port robotic dismembered pyeloplasty through a mini-Pfannenstiel access allows a same-day discharge protocol with minimal opiate use.
分析单孔（SP）机器人肾盂成形术后当日出院方案的可行性。
对2018年2月至2021年3月期间在单一机构接受初次机器人离断性肾盂成形术的23例患者（12例多孔，11例单孔）进行分析。采用卡方检验、Fisher精确检验、Mann-Whitney U检验和t检验分析基线和围手术期特征与功能结局之间的关联。
所有单孔病例均通过迷你Pfannenstiel切口完成，无需中转或增加切口。基线特征具有可比性。未观察到术中并发症。单孔组仅1例患者出现Clavien II级并发症。多孔组所有患者均放置了引流管，而单孔组未放置引流管。单孔组住院时间较短（11.4小时对42.6小时，P <.001）。虽然出院时视觉模拟疼痛评分具有可比性（P = 0.633），但单孔组住院期间阿片类药物使用量（吗啡毫克当量）较低（P <.001），出院时阿片类药物处方率也较低（18.2%对91.7%，P <.001）。中位随访8个月时，无患者出现胁腹疼痛，所有患者随访影像显示肾脏引流良好。
通过迷你Pfannenstiel入路进行单孔机器人离断性肾盂成形术可实现当日出院方案，且阿片类药物使用量最少。
