Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutional comparison of outcomes and learning curves

Andolfi, Ciro; Lombardo, Alyssa; Aizen, Joshua; Walker, Jonathan; Barashi, Nimrod; Reed, Francisco; López, Pedro-José; Wilcox, Duncan T.; Gundeti, Mohan S.

doi:10.1007/s00345-022-03929-0

Cited by 17 publications

(29 citation statements)

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“…The initial review retrieved 811 studies from databases using keywords “Pyeloplasty” AND “Infants.” Thanks to the screening of all these titles and abstracts, we selected 70 papers focusing on infants or children <15 kg of weight with UPJO. Among these, only 13 publications were comparative studies between OP vs. MIS ( 1 , 13 , 22 – 32 ) ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies compared OP vs. LAP + RALP ( 13 , 28 ); one was excluded ( 28 ) due to incomplete information. Two papers ( 23 , 29 ) treating RALP vs.…”

Section: Resultsmentioning

confidence: 99%

“…Nine articles were included in the meta-analysis, eight retrospective studies ( 1 , 22 , 24 – 27 , 30 , 32 ) and one prospective study ( 13 ).…”

Section: Resultsmentioning

confidence: 99%

“…The length of postoperative follow-up has been reported in five papers (13,25,26,30,32). OP presented a longer but not significant follow-up than MIS [21.5 ± 8.1 months vs. 13.9 ± 4.7 months, respectively; p = ns; MD: 7.03, 95% CI: (−2.23-16.29), Table 2 and Figure Forest plot comparison of the incidence of postoperative complications between OP and MIS in infants.…”

Section: Figurementioning

confidence: 99%

“…However, most of them have reported outcomes in a reduced number of cases. RALP has been reported to simplify the MIS approach in children,, with results comparable to OP ( 13 ). However, to the best of our knowledge, only a few studies were focused on infants.…”

Section: Introductionmentioning

confidence: 99%

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Ureteropelvic junction obstruction in infants: Open or minimally invasive surgery? A systematic review and meta-analysis

et al. 2022

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IntroductionThe historical gold standard treatment for ureteropelvic junction obstruction (UPJO) was the open Anderson–Hynes dismembered pyeloplasty (OP). Minimally invasive surgery (MIS) procedures, including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), have been reported to achieve better outcomes (i.e., decreased morbidity, reduced postoperative pain, superior esthetic results, and shortened length of hospital stay, LOS), with a success rate similar to OP. The main limitation of the MIS approach is the age and weight of patients, limiting these procedures to children >1 year. This study aims to evaluate the feasibility and benefits of MIS pyeloplasty compared to OP to surgically treat UPJO in children <1 year of age.Materials and methodsA systematic review was independently performed by two authors. Papers comparing both techniques (MIS pyeloplasty vs. OP) in infants were included in the meta-analysis. Data (mean ± DS or percentage) were analyzed using Rev.Man 5.4 A p < 0.05 was considered significant.ResultsNine studies (eight retrospective and one prospective) meet the inclusion criteria. A total of 3,145 pyeloplasties have been included, with 2,859 (90.9%) OP and 286 (9.1%) MIS. Age at operation was 4.9 ± 1.4 months in OP vs. 5.8 ± 2.2 months in MIS, p = ns. Weight at surgery was 6.4 ± 1.4 kg in OP vs. 6.9 ± 1.4 kg in MIS, p = ns. Operative time was 129.4 ± 24.1 min for OP vs. 144.0 ± 32.3 min for MIS, p < 0.001. LOS was 3.2 ± 1.9 days for OP vs. 2.2 ± 0.9 days for MIS, p < 0.01. Postoperative complications were present in 10.0 ± 12.9% of OP vs. 10.9 ± 11.6% in MIS, p = ns. Failure of surgery was 5.2 ± 3.5% for OP vs. 4.2 ± 3.3% for MIS, p = ns.ConclusionThe development of miniaturized instruments and technical modifications has made MIS feasible and safe in infants and small children. MIS presented a longer operative time than OP. However, MIS seemed effective for treating UPJO in infants, showing shortened LOS compared to OP. No differences have been reported with regard to the incidence of postoperative complications and failure of pyeloplasty. Given the low quality of evidence of the meta-analysis according to the GRADE methodology, we would suggest limiting MIS procedures in infants to only those high-volume centers with experienced surgeons.

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Section: Resultsmentioning

confidence: 99%

“…Two studies compared OP vs. LAP + RALP ( 13 , 28 ); one was excluded ( 28 ) due to incomplete information. Two papers ( 23 , 29 ) treating RALP vs.…”

Section: Resultsmentioning

confidence: 99%