Rensing Adam J, Qadar Abdul, Higganbotham Clark, Frimberger Dominic, Meenakshi-Sundaram Bhalaajee
University of Oklahoma Health Sciences Center (HSC), Department of Urology, Oklahoma City, OK, United States.
Front Urol. 2023 Jan 30;3:1103915. doi: 10.3389/fruro.2023.1103915. eCollection 2023.
While undescended testes are relatively common, the nonpalpable testis remains a challenging problem. The gold standard treatment remains the laparoscopic orchiopexy. However, today robot-assisted surgery has challenged traditional laparoscopy in many areas of urology. Yet the value of this new approach remains controversial, given concerns with operative time and cost. We reviewed our contemporary results of both robot-assisted orchiopexy (RALO) and traditional laparoscopic orchiopexy (TLO). Our primary aims were to retrospectively compare success rates, and operative time. Our secondary aims were to compare costs and complications related to each method.
In this study, all patients treated with laparoscopic and robot-assisted laparoscopic orchiopexy from April 2017 to January 2022 were reviewed using CPT code 54692. Exclusion criteria included bilateral concomitant orchiopexy or concomitant "major surgery," or follow up less than 6 months. Also excluded were 1 stage orchiopexies. For the purposes of comparison, 1-stage and 2 stage orchiopexies were included in the analysis. Patient demographics, surgical operative notes and documentation were all reviewed.
After exclusion criteria was applied, 16 and 17 remained in the laparoscopic and robot-assisted cohorts, respectively. Upon follow up, all patients in both the laparoscopic and robot-assisted cohorts were noted to have a healthy testicle palpable in the dependent portion of the scrotum. The median operative time in the TLO group was 71 minutes, compared to 101 minutes in the RALO group (p>0.0001). When comparing median hospital charges, the TLO group was lower at $38,813, compared to $46,455 in the RALO group (p = 0.0069). There was one postoperative complication in the TLO group (localized wound infection), compared to zero in the RALO group.
The robot-assisted orchiopexy is safe and effective. However, at this time it remains more costly in terms of time and resources.
虽然隐睾相对常见，但不可触及的睾丸仍然是一个具有挑战性的问题。金标准治疗方法仍然是腹腔镜睾丸固定术。然而，如今机器人辅助手术在泌尿外科的许多领域对传统腹腔镜手术提出了挑战。然而，鉴于对手术时间和成本的担忧，这种新方法的价值仍存在争议。我们回顾了我们当代机器人辅助睾丸固定术（RALO）和传统腹腔镜睾丸固定术（TLO）的结果。我们的主要目的是回顾性比较成功率和手术时间。我们的次要目的是比较每种方法的成本和并发症。
在本研究中，使用CPT代码54692对2017年4月至2022年1月期间接受腹腔镜和机器人辅助腹腔镜睾丸固定术治疗的所有患者进行了回顾。排除标准包括双侧同时进行睾丸固定术或同时进行“大手术”，或随访时间少于6个月。一期睾丸固定术也被排除。为了进行比较，分析中纳入了一期和二期睾丸固定术。对患者人口统计学、手术记录和文档进行了全面审查。
应用排除标准后，腹腔镜组和机器人辅助组分别剩下16例和17例。随访时，腹腔镜组和机器人辅助组的所有患者阴囊下垂部位均可触及健康的睾丸。TLO组的中位手术时间为71分钟，而RALO组为101分钟（p>0.0001）。比较中位住院费用时，TLO组较低，为38,813美元，而RALO组为46,455美元（p = 0.0069）。TLO组有1例术后并发症（局部伤口感染），而RALO组为零。
机器人辅助睾丸固定术是安全有效的。然而，目前在时间和资源方面，它的成本仍然更高。
