Vidhya Tamizhvanan, Rajiv Padankatti, Sripathi Venkat
Department of Pediatric Urology, Apollo Childen's Hospital, Chennai, India.
Front Pediatr. 2024 Jun 26;12:1376644. doi: 10.3389/fped.2024.1376644. eCollection 2024.
This study aims to analyze the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO) over a 10-year period at a tertiary care center in South India.
This study provides a detailed analysis of prospectively acquired data from 2013 to 2023 of all children who underwent RALP at our institution. Pre- and post-operative renal ultrasound and isotope renography were used to assess outcomes. Detailed information on patient demographics, procedural duration, post-operative pain relief, operation steps, and post-surgical follow-up protocols has been provided. The analysis included all patients who completed a 1-year follow-up.
Between 2013 and 2023, 201 children underwent RALP. Of these, 185 children completed at least 1 year of follow-up and were included in the analysis. The mean age of the cohort was 4.9 years (1 month to 17 years), with males comprising the majority (77.3%). Twenty-five children (13.5%) were younger than 1 year of age. Left-sided PUJO was found to be more common. The mean console time was 76.5 min (40-180 min), and the average hospital stay was 2.8 days (2-5). After surgery, the mean reduction in antero-posterior diameter of the renal pelvis was more than 50% of its pre-operative value and statistically significant (3.3 ± 0.3 to 1.9 ± 0.9 cm). At the end of 1 year, the overall reduction in renal size was also significant (9.7 ± 2.3 cm pre-operative to 8.9 ± 1.8 cm post-operative). The pre-operative Society of Fetal Urology (SFU) grade of hydronephrosis was compared to the post-operative SFU grade, and the improvement (resolution/downgrading) was found to be statistically significant. The median split renal function in this series was 39% pre-operative and 43% post-operative, and the overall functional improvement after RALP was significant. A successful outcome was observed in 181 children (97.8%). Four children experienced persistent severe hydronephrosis and underwent redo stenting and/or redo pyeloplasty (2.1% failure rate). Post-operative complications, according to the Clavien-Dindo classification, were classified as type 1 in three children and type 3b in two children. There were no conversions to open surgery in the series.
RALP emerges as the minimally invasive procedure of choice for children with PUJO at our institution. It is safe, delivering consistently excellent results and minimal complications. Our outcomes are comparable to those of previously published series. We trust that our experience will serve as a roadmap for those centers (especially in South Asia) embarking on a pediatric robotic program.
本研究旨在分析在印度南部一家三级医疗中心，10年间接受机器人辅助腹腔镜肾盂成形术（RALP）治疗肾盂输尿管连接部梗阻（PUJO）患儿的手术结果。
本研究对2013年至2023年期间在我院接受RALP手术的所有患儿的前瞻性获取数据进行了详细分析。术前和术后的肾脏超声及同位素肾图用于评估手术结果。提供了关于患者人口统计学、手术时间、术后疼痛缓解、手术步骤及术后随访方案的详细信息。分析纳入了所有完成1年随访的患者。
2013年至2023年期间，201名儿童接受了RALP手术。其中，185名儿童完成了至少1年的随访并纳入分析。该队列的平均年龄为4.9岁（1个月至17岁），男性占大多数（77.3%）。25名儿童（13.5%）年龄小于1岁。发现左侧PUJO更为常见。平均控制台操作时间为76.5分钟（40 - 180分钟），平均住院时间为2.8天（2 - 5天）。术后，肾盂前后径的平均缩小幅度超过术前值的50%，且具有统计学意义（术前3.3±0.3厘米至术后1.9±0.9厘米）。在1年末，肾脏大小的总体缩小也具有统计学意义（术前9.7±2.3厘米至术后8.9±1.8厘米）。将术前胎儿泌尿外科学会（SFU）肾积水分级与术后SFU分级进行比较，发现改善情况（消退/降级）具有统计学意义。本系列患者术前平均分肾功能为39%，术后为43%，RALP术后总体功能改善显著。181名儿童（97.8%）手术结果成功。4名儿童出现持续性重度肾积水，接受了再次支架置入和/或再次肾盂成形术（失败率2.1%）。根据Clavien - Dindo分类法，术后并发症在3名儿童中为1型，在2名儿童中为3b型。本系列中无转为开放手术的情况。
在我们机构，RALP成为治疗PUJO患儿的首选微创手术。它安全可靠，能持续带来优异的手术效果且并发症极少。我们的手术结果与先前发表的系列研究相当。我们相信我们的经验将为那些开展小儿机器人手术项目的中心（尤其是南亚地区）提供参考。
