Cobellis Giovanni, Bindi Edoardo
Pediatric Surgery Unit, Salesi Children's Hospital, Via F. Corridoni 11, 60123 Ancona, Italy.
Department of Pediatric Surgery, Università Politecnica of Marche, 60121 Ancona, Italy.
Children (Basel). 2023 Aug 25;10(9):1448. doi: 10.3390/children10091448.
Robot-assisted pyeloplasty is widely used in pediatric surgery because of its well-known advantages over open or laparoscopic surgery. The aim is to explore our experience and evaluate the achievements we have made.
We evaluated patients undergoing robotic pyeloplasty from January 2016 to November 2021, including those who presented with a ureteropelvic junction obstruction associated with other anomalies of the kidney. The parameters examined were: age, weight, associated renal malformations, conversion rate, operative time, and intra- and postoperative complications.
Of 39 patients, 7 (20%) were included, of whom 5 (71%) were male and 2 (29%) were female. The mean age at surgery was 84 months (range 36-180 months), and the mean weight at surgery was 24.4 kg (range 11-40 kg). In five (71%) patients the ureteropelvic junction obstruction (UPJO) was left-sided and in two (29%) it was right-sided. In four (57%) cases, UPJO was associated with a horseshoe kidney, right-sided in one (25%) patient, and left-sided in the other three (75%). A 180° rotation of the kidney was present in one (14%) patient. Nephrolithiasis was present in two (29%) patients. The mean operative time was 160 min (range 140-240 min). The average bladder catheter dwell time was 1 day (range 2-3 days), while the average abdominal drainage dwell time was 2 days (range 2-4 days). The mean hospitalization time was 4 days (range 3-9 days). On average, after 45 days (range 30-65) the JJ ureteral stent was removed cystoscopically. No intraoperative complications were reported, while one case of persistent macrohematuria with anemia requiring blood transfusion occurred postoperatively.
Ureteropelvic junction obstruction might be associated with other congenital urinary tract anomalies such as a duplicated collecting system, horseshoe kidney, or pelvic kidney. These kinds of malformations can complicate surgery and require more attention and accuracy from the surgeon. Our experience shows that, with regards to the robotic learning curve required for pyeloplasty, the treatment of the ureteropelvic junction in these situations does not present insurmountable difficulties nor is burdened by complications. The application of robot-assisted surgery in pediatric urology makes difficult pyeloplasties easier.
机器人辅助肾盂成形术因其相对于开放手术或腹腔镜手术具有众所周知的优势，在小儿外科中被广泛应用。目的是探索我们的经验并评估所取得的成果。
我们评估了2016年1月至2021年11月期间接受机器人肾盂成形术的患者，包括那些伴有肾盂输尿管连接部梗阻及其他肾脏异常的患者。所检查的参数包括：年龄、体重、相关肾脏畸形、中转率、手术时间以及术中和术后并发症。
39例患者中，7例（20%）被纳入研究，其中5例（71%）为男性，2例（29%）为女性。手术时的平均年龄为84个月（范围36 - 180个月），手术时的平均体重为24.4千克（范围11 - 40千克）。5例（71%）患者的肾盂输尿管连接部梗阻位于左侧，2例（29%）位于右侧。4例（57%）病例中，肾盂输尿管连接部梗阻与马蹄肾相关，其中1例（25%）患者马蹄肾位于右侧，另外3例（75%）位于左侧。1例（14%）患者存在肾脏180°旋转。2例（29%）患者存在肾结石。平均手术时间为160分钟（范围140 - 240分钟）。膀胱导管平均留置时间为1天（范围2 - 3天），而腹部引流管平均留置时间为2天（范围2 - 4天）。平均住院时间为4天（范围3 - 9天）。平均在45天（范围30 - 65天）后经膀胱镜取出双J输尿管支架。未报告术中并发症，术后发生1例持续性肉眼血尿伴贫血需要输血的病例。
肾盂输尿管连接部梗阻可能与其他先天性泌尿系统异常相关，如重复集合系统、马蹄肾或盆腔肾。这类畸形会使手术复杂化，需要外科医生更加关注并提高操作准确性。我们的经验表明，就肾盂成形术所需的机器人学习曲线而言，在这些情况下治疗肾盂输尿管连接部并不存在不可克服的困难，也不会受到并发症的困扰。机器人辅助手术在小儿泌尿外科的应用使复杂的肾盂成形术变得更容易。
