Moretto Stefano, Gandi Carlo, Bientinesi Riccardo, Totaro Angelo, Marino Filippo, Gavi Filippo, Russo Andrea, Aceto Paola, Pierconti Francesco, Bassi Pierfrancesco, Sacco Emilio
Department of Urology, Università Cattolica del Sacro Cuore di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Department of Emergency, Anesthesiological and Reanimation Sciences, Università Cattolica del Sacro Cuore di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
J Clin Med. 2023 Mar 28;12(7):2538. doi: 10.3390/jcm12072538.
We designed a retrospective study to assess the surgical and economic outcomes of robot-assisted laparoscopic pyeloplasty (RALP) compared with open pyeloplasty (OP), including consecutive patients suffering from ureteropelvic junction obstruction and operated on from January 2012 to January 2022 at a single center. Preoperative, intraoperative, and postoperative outcomes, including costs, were comparatively analyzed. The primary outcome was 3-month success, defined as symptom resolution and no obstruction upon diuretic renal scintigraphy. Overall, 91 patients were included (48 OP and 43 RALP). The success rate at 3 months was 93.0% and 83.3% in the RALP and OP group, respectively ( = 0.178), and the results remained stable at the last follow-up (35.4 ± 22.8 months and 56.0 ± 28.1 months, respectively). Intraoperative blood loss ( < 0.001), need for postoperative analgesics ( = 0.019) and antibiotics ( = 0.004), and early postoperative complication rate ( = 0.009) were significantly lower in the RALP group. None of the assessed variables were a predictor for failure. The mean total direct cost per surgical procedure and related hospital stay was 2373 € higher in the RALP group. RALP is an effective and safe treatment for ureteropelvic junction obstruction; however, further studies are needed to evaluate the cost-effectiveness of RALP, accounting for indirect costs and cost-saving with new surgical platforms.
我们设计了一项回顾性研究，以评估机器人辅助腹腔镜肾盂成形术（RALP）与开放性肾盂成形术（OP）相比的手术和经济结果，研究对象包括2012年1月至2022年1月在单一中心接受手术治疗的连续性输尿管肾盂连接处梗阻患者。对术前、术中和术后结果（包括费用）进行了比较分析。主要结局指标为术后3个月成功，定义为症状缓解且利尿肾动态显像无梗阻。总体而言，共纳入91例患者（48例接受OP，43例接受RALP）。RALP组和OP组术后3个月的成功率分别为93.0%和83.3%（P = 0.178），在末次随访时结果保持稳定（分别为35.4 ± 22.8个月和56.0 ± 28.1个月）。RALP组术中失血量（P < 0.001）、术后镇痛需求（P = 0.019）和抗生素使用（P = 0.004）以及术后早期并发症发生率（P = 0.009）均显著更低。所有评估变量均不是失败的预测因素。RALP组每例手术及相关住院的平均总直接费用高出2373欧元。RALP是治疗输尿管肾盂连接处梗阻的一种有效且安全的方法；然而，需要进一步研究以评估RALP的成本效益，同时考虑间接成本以及新手术平台带来的成本节约。
