Shamir Medical Center, Be'er Ya'akov, Israel.
Shamir Medical Center, Be'er Ya'akov, Israel.
Urology. 2024 Apr;186:166-171. doi: 10.1016/j.urology.2024.02.021. Epub 2024 Feb 22.
To evaluate the outcomes of children with vesicoureteral reflux (VUR) and obstructive megaureter (OM) utilizing various laparoscopic and robot-assisted approaches.
Retrospective review of all pediatric laparoscopic and robot-assisted cases for lower ureter pathology was performed between 2016-2022 in 13 academic centers worldwide. Five surgical approaches were assessed: LEUR, LVCUR, LDECUR, RALUR, and RADECUR.
One thousand three hundred forty-three patients (490 boys and 853 girls) with a median age of 30 months (IQR 12-63) were treated at 13 centers. Nine hundred and eight patients (68%) underwent reimplantation due to VUR (unilateral in 818 and bilateral in 90 patients). Four hundred thirty-five (32%) had a surgery due to ureterovesical junction (UVJ) obstruction. Mean length of follow-up was 14 months (IQR 8-33). Median operative time was 202 minutes (IQR 142-220) in the robotic arm compared to 240 minutes (IQR 160-267) in the laparoscopic (P = .45). Intracorporeal excisional tapering was performed in 118 (8%) of the patients. Six patients in the OM group required additional surgery due to progressive obstruction. In the VUR group, 84% underwent voiding cystourethrography postoperatively. 5.6% showed residual reflux. Grade 1-2 Clavien-Dindo complications occurred in 10 patients (0.7%) and 6 (0.4%) in the laparoscopic and robotic arm, respectively. Grade 3 complications occurred in 17 (1.2%) and 8 (0.5%) in both arms, respectively. Surgical success was achieved in 96% of patients.
Laparoscopic and robot-assisted laparoscopic approaches are simple, safe, and effective for treating all grades of VUR and OM. Robot-assisted approach is beneficial in terms of operative time, intracorporeal suturing, and lower complications rate.
评估利用各种腹腔镜和机器人辅助方法治疗儿童膀胱输尿管反流（VUR）和输尿管扩张症（OM）的结果。
对 2016 年至 2022 年期间全球 13 个学术中心的所有小儿腹腔镜和机器人辅助下治疗下尿路病变的病例进行了回顾性研究。评估了 5 种手术方法：LEUR、LVCUR、LDECUR、RALUR 和 RADECUR。
1343 例患者（490 名男孩和 853 名女孩）纳入研究，中位年龄为 30 个月（IQR 12-63）。908 例（68%）因 VUR 接受了再植术（单侧 818 例，双侧 90 例）。435 例（32%）因输尿管膀胱连接部梗阻接受了手术。平均随访时间为 14 个月（IQR 8-33）。机器人组的中位手术时间为 202 分钟（IQR 142-220），腹腔镜组为 240 分钟（IQR 160-267）（P=.45）。118 例（8%）患者行腔内切除缩窄术。OM 组中有 6 例因进行性梗阻需要额外手术。在 VUR 组中，84%的患者术后行排尿性膀胱尿道造影。5.6%的患者仍存在残余反流。腹腔镜组和机器人组各有 10 例（0.7%）和 6 例（0.4%）患者发生 1-2 级 Clavien-Dindo 并发症，两组各有 17 例（1.2%）和 8 例（0.5%）患者发生 3 级并发症。96%的患者手术成功。
腹腔镜和机器人辅助腹腔镜方法是治疗所有等级的 VUR 和 OM 的简单、安全和有效的方法。机器人辅助方法在手术时间、腔内缝合和较低的并发症发生率方面具有优势。
