Chun Brian, Ayyash Omar, Schneck Francis X, Chaudhry Rajeev, Ost Michael C, Cannon Glenn M
UPMC Children's Hospital of Pittsburgh, Division of Urology, Pittsburgh, PA, USA; Children's Hospital Los Angeles, Division of Urology, Los Angeles, CA, USA.
UPMC Children's Hospital of Pittsburgh, Division of Urology, Pittsburgh, PA, USA.
J Pediatr Urol. 2025 Jul 21. doi: 10.1016/j.jpurol.2025.07.022.
Robot-assisted laparoscopic pyeloplasty (RALP) is widely used for the treatment of ureteropelvic junction obstruction (UPJO), however a robotic approach has been associated with higher surgery cost. A large portion of robotic surgery costs are related to modifiable direct expenses that are influenced by operating room (OR) time. The Da Vinci Xi surgical platform offers many technical improvements designed to improve efficiency and reduce OR time.
To compare operative time and perioperative outcomes for RALP with the Da Vinci Si and Xi platforms at our institution. We hypothesized that the Xi system would be associated with reduced total operative time and similar success rates.
We performed a retrospective chart review of all pediatric patients ≤21 years of age undergoing RALP at our institution between 2019 and 2022 and compared outcomes for surgeries performed with the Si and Xi platforms. Bilateral procedures, re-do pyeloplasty, and patients undergoing other procedures at the time of RALP were excluded. Primary outcome was operating room (OR) time. Secondary outcomes were length of inpatient stay, estimated blood loss (EBL), and post-operative improvement in hydronephrosis.
101 RALP surgeries were included in our final analysis. There were no differences in median age (p = 0.66), laterality (p = 0.4), sex (p = 0.78), reason for presentation (p = 0.90), preoperative hydronephrosis (p = 0.22), presence of parenchymal thinning (p = 0.23), and median split function of the affected kidney (p = 0.44) between Si and Xi cohorts. Mean operative time was 25 min shorter in the Xi cohort compared to the Si cohort (p = 0.02). Radiographic improvement in hydronephrosis and post-operative length of stay were similar in both cohorts (p = 0.37 and p = 0.13, respectively).
At our institution, RALP with the Da Vinci Xi platform was associated with a 25 min shorter operative time compared to the Si platform. This improvement in OR utilization reduces direct surgical costs and may increase the overall cost effectiveness of robotic surgery. Our study has several limitations: first, it is a single-institution retrospective series from a nonprofit, academic pediatric hospital; second, only total operative time was measured as our institution does not separately record console and docking times; third, estimated blood loss and radiographic improvement in hydronephrosis was surgeon reported; fourth, our cost analysis was limited to direct surgical costs.
Pediatric robotic-assisted laparoscopic pyeloplasty (RALP) using the Da Vinci Xi surgical system has a similar high success rate and is associated with shorter operative time compared to the Da Vinci Si system.
机器人辅助腹腔镜肾盂成形术（RALP）广泛用于治疗肾盂输尿管连接部梗阻（UPJO），然而机器人手术方式的手术成本较高。机器人手术成本的很大一部分与可调整的直接费用相关，这些费用受手术室（OR）时间影响。达芬奇Xi手术平台进行了多项技术改进，旨在提高效率并减少手术室时间。
比较我院使用达芬奇Si和Xi平台进行RALP的手术时间和围手术期结果。我们假设Xi系统将减少总手术时间且成功率相似。
我们对2019年至2022年间在我院接受RALP的所有≤21岁儿科患者进行了回顾性病历审查，并比较了使用Si和Xi平台进行手术的结果。排除双侧手术、再次肾盂成形术以及在RALP时接受其他手术的患者。主要结局是手术室（OR）时间。次要结局是住院时间、估计失血量（EBL）以及肾积水术后改善情况。
101例RALP手术纳入我们的最终分析。Si组和Xi组在中位年龄（p = 0.66）、患侧（p = 0.4）、性别（p = 0.78）、就诊原因（p = 0.90）、术前肾积水（p = 0.22）、实质变薄情况（p = 0.23）以及患侧肾脏的中位分肾功能（p = 0.44）方面无差异。与Si组相比，Xi组的平均手术时间短25分钟（p = 0.02）。两组肾积水的影像学改善和术后住院时间相似（分别为p = 0.37和p = 0.13）。
在我院，与Si平台相比，使用达芬奇Xi平台进行RALP的手术时间缩短了25分钟。手术室利用率的这种提高降低了直接手术成本，并可能提高机器人手术的整体成本效益。我们的研究有几个局限性：第一，这是一家非营利性学术儿科医院的单机构回顾性系列研究；第二，由于我院未单独记录控制台和对接时间，仅测量了总手术时间；第三，估计失血量和肾积水的影像学改善情况由外科医生报告；第四，我们的成本分析仅限于直接手术成本。
与达芬奇Si系统相比，使用达芬奇Xi手术系统进行小儿机器人辅助腹腔镜肾盂成形术（RALP）成功率相似且手术时间更短。
