Comparison of Surgical and Functional Outcomes of Minimally Invasive and Open Pyeloplasty

Boylu, Uğur; Başataç, Cem; Turan, Turgay; Önol, Fikret Fatih; Gümüş, Eyüp

doi:10.1089/lap.2012.0142

Cited by 18 publications

(16 citation statements)

References 23 publications

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“…[11] In another study, surgical, and functional outcomes of 20 patients who had undergone minimally invasive transperitoneal pyeloplasty (13 robotic, and 7 laparoscopic procedures), and 22 cases who experienced open pyeloplasty were compared. [12] Operative times did not differ significantly between groups, while amount of bleeding, hospital stay, and time to removal of the drain were found to be significantly shorter in the minimally invasive group. Radiological, and symptomatic improvement rates were detected as 95.5, and 95% in the open surgery, and minimally invasive groups, respectively.…”

Section: Discussionmentioning

confidence: 77%

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Ener

Altinova

Canda

et al. 2014

Turkish Journal of Urology

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Objective: We evaluated outcomes of our robot-assisted laparoscopic transperitoneal pyeloplasty (RALP) procedures. Material and methods:Between July 2011 and March 2014, 18 RALP procedures were performed at our instutition. Ureteropelvic junction obstruction (UPJO) diagnosis was made based on clinical presentation and intravenous urography. All patients underwent basal and diuretic isotopic renography to evaluate the degree of obstruction and impaired renal function. Anderson-Hynes dismembered pyeloplasty technique was used with a transperitoneal approach by using the da Vinci-S 4-arm surgical robot. Outcomes were assessed retrospectively.Results: Mean patient age was 31.3±11.7 (13-62) years. Male: female ratio was 9: 9. All procedures were primary surgeries. Of 18 patients, 10 (55.5%) had a crossing vessel and 8 (44.5%) had intrinsic obstruction. Conclusion: Due to our experience, RALP is a safe and feasible minimally invasive approach in patients with UPJO with excellent surgical and functional outcomes.

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Section: Discussionmentioning

confidence: 77%

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Ener

Altinova

Canda

et al. 2014

Turkish Journal of Urology

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“…9,10 The advantages of robot-assisted surgery over conventional laparoscopy include elimination of surgeon hand tremor, conceivably a shorter learning curve, especially for intracorporeal suturing because of the wristed instruments, and a shorter operative time. 9,11 The shorter operative time for robot-assisted laparoscopic pyeloplasty (RLP) seems to be more and more prominent in recently published studies.…”

mentioning

confidence: 99%

“…Published studies that compare LP versus RLP have mostly reported a shorter operative time with RLP, mainly in the 10-to 30-minute range. [9][10][11][12][13] This difference may be thought to depend mainly on the surgeon's comfort level with laparoscopic suturing, which arguably is the rate-limiting step of the procedure. These studies do not show any significant difference between the two techniques in terms of length of stay in hospital, success rate, complications, and safety.…”

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confidence: 99%

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Robot-assisted laparoscopic pyeloplasty: current status and future directions

Akhavein¹,

Bird²

2015

RSRR

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Ureteropelvic junction obstruction is an impairment of urine flow across the ureteropelvic junction and warrants surgical treatment (pyeloplasty) when clinically significant. Pyeloplasty techniques have undergone significant evolution over time, but dismembered pyeloplasty remains the gold standard for treatment, offering excellent success rate and durable results coupled with low complications. With the advent of minimally invasive surgery (MIS), dismembered pyeloplasty has been performed via MIS since the 1990s, and currently more than half of all pyeloplasties are done in this manner in the US. MIS pyeloplasty has proven benefits that include smaller incisions, shorter hospital stay, reduced blood loss, and less postoperative analgesic requirement. Robot-assisted laparoscopic pyeloplasty (RLP) adds a shorter operative time, elimination of surgeon's hand tremor, and likely a shorter surgeon learning curve by providing wristed instruments and better vision for easier suturing. However, studies have shown RLP to be costlier, which can be ameliorated by higher patient throughput, minimizing surgeon learning curve, and possible future availability of other robotic systems, leading to competition and cost reduction. State-of-the-art robotic surgical developments include single-incision surgery, for which different options are currently available and more are being developed. These efforts will likely lead to development and popularization of new dedicated robotic single-site surgical platforms and solitary intracorporeal stems with deployable camera and instruments. These technological advances will inevitably be incorporated into pyeloplasty, resulting in reduced costs and availability of more surgical options in this area.

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“…In many studies, efficacy of laparoscopic approach has been compared with traditional open pyeloplasty, and similar success rates have been reported. [12][13][14][15] Procedural success rate varies between 88-100%, based on subjective, and objective success criteria. [16] Although when compared with open surgery, lesser incisional morbidity, postoperative pain, and shorter hospitalization period, requirement for highly experienced suturing technique, and longer operative times are seen as disadvantages of this method.…”

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confidence: 99%

Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction

Başataç

Boylu

Önol

et al. 2014

Turkish Journal of Urology

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Objective: To compare the surgical and functional outcomes of open, laparoscopic and robotic dismembered pyeloplasty for the treatment of patients with ureteropelvic junction obstruction (UPJO). Material and methods:Between 2007 and 2012, a total of 56 patients underwent conventional open (Group 1; n=25), laparoscopic (Group 2; n=16), and robotic (Group 3; n=15) dismembered pyeloplasty operations. Preoperative evaluation was performed using urinalysis, urine culture, blood biochemistry, urinary ultrasound, intravenous pyelogram (IVP) (optional) and Mercaptoacetyltriglycine (MAG-3) renal scan. The mean operation time, estimated blood loss, drain removal time, narcotic analgesic requirements, length of hospital stay and functional outcomes were compared among groups. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) v. 20 (IBM, Armonk, NY, USA) software, and statistically significant differences were determined using a p value <0.05. Results:The mean age of the patients was 30 years in Group 1, 34.3 years in Group 2 and 32.9 years in Group 3. The mean operation time was 127, 130 and 114 min (p=0.32), and the estimated blood loss was 105, 31 and 28 mL, respectively (p=0.001). The drain was removed after 4.36 (±1.3), 2.33 (±0.6) and 1.8 (±0.6) days after surgery (p<0.001), and the mean hospital stay was 4.14 (±1.8), 2.8 (±0.75) and 2 (±1) days, respectively (p<0.001). Narcotic analgesic requirement was significantly higher in Group 1 compared with Groups 2 and 3 (p=0.02). The radiographic and symptomatic success rates were 96% in Group 1, 93.75% in Group 2 and 93.3% in Group 3. Conclusion:Laparoscopic and robotic pyeloplasty are feasible, effective, reliable and minimally invasive treatment approaches for the treatment of UPJO as compared with open dismembered pyeloplasty.

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Comparison of Surgical and Functional Outcomes of Minimally Invasive and Open Pyeloplasty

Abstract: Minimally invasive pyeloplasty has low morbidity, short length of stay, and less blood loss compared with open surgical repair. It is an effective and feasible minimally invasive treatment modality for ureteropelvic junction obstruction.

Cited by 18 publications

References 23 publications

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

Robot-assisted laparoscopic pyeloplasty: current status and future directions

Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction

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