Pediatric Urology, Section of Urology, Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Comer Children's Hospital Chicago, IL, USA.
J Endourol. 2022 Apr;36(4):448-461. doi: 10.1089/end.2021.0363.
To perform a systematic review (SR) and meta-analysis (MA) of outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction (UPJ) obstruction in children. A SR of the English-language literature on surgical techniques and perioperative outcomes of RALP for UPJ obstruction in children was performed without time filters using the MEDLINE (through PubMed), EMBASE, and Cochrane databases in July 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement recommendations. Overall, 58 studies were selected for qualitative analysis, 46 of which were included in the MA. Nearly all studies included were observational and retrospective, either cohort or case-control. The quality of evidence was assessed using Modified Newcastle-Ottawa Scoring, with the majority of studies scoring medium or high quality. The mean success rate was 95.4% (confidence interval 91.0%-99.3%), over a wide age range. There was a noticeable heterogeneity in reported follow-up length and definitions of success rate. The majority of studies reported length of stay of ∼1 day. The mean overall complication rate was 12%. For studies that reported complication rate by grade, the mean low Clavien grade (Grade 2 or less) complication rate was 9.3% and the mean high Clavien grade (Grade 3 or more) complication rate was 6.5%. Robot-assisted surgery is technically feasible and has been shown to achieve very favorable outcomes for pyeloplasty in children. The evidence, however, is mostly retrospective and from single sites, which introduces potential biases. Further research is needed to further elucidate RALP benefits compared with the open and laparoscopic approach. As a randomized control trial may not be practical in this space, perhaps a prospective multi-institutional design with a uniform reporting system of pediatric RALP is the next step to define its benefits and limits.
为了对机器人辅助腹腔镜肾盂成形术（RALP）治疗儿童肾盂输尿管连接部（UPJ）梗阻的结局进行系统评价（SR）和荟萃分析（MA）。2020 年 7 月，根据系统评价和荟萃分析报告的首选报告项目建议，我们对 MEDLINE（通过 PubMed）、EMBASE 和 Cochrane 数据库中关于 RALP 治疗儿童 UPJ 梗阻的手术技术和围手术期结局的英文文献进行了无时间限制的 SR。总体而言，对 58 项研究进行了定性分析，其中 46 项研究纳入了 MA。几乎所有纳入的研究都是观察性和回顾性的，包括队列或病例对照研究。使用改良纽卡斯尔-渥太华评分法评估证据质量，大多数研究的评分均为中等或高质量。成功率的平均值为 95.4%（置信区间 91.0%-99.3%），年龄范围广泛。报告的随访时间和成功率定义存在明显的异质性。大多数研究报告的住院时间约为 1 天。总体并发症发生率的平均值为 12%。对于报告按等级分类的并发症发生率的研究，低 Clavien 等级（等级 2 或以下）并发症发生率的平均值为 9.3%，高 Clavien 等级（等级 3 或以上）并发症发生率的平均值为 6.5%。机器人辅助手术在技术上是可行的，并且已经证明对儿童肾盂成形术具有非常有利的结果。然而，证据主要是回顾性的，且来自单一站点，这引入了潜在的偏倚。需要进一步的研究来进一步阐明 RALP 与开放和腹腔镜方法相比的优势。由于在这个领域进行随机对照试验可能不切实际，因此或许前瞻性的多机构设计和统一的儿童 RALP 报告系统是下一步，以确定其优势和局限性。
