Meta‐analysis of robot‐assisted vs conventional laparoscopic and open pyeloplasty in children

Cundy, Thomas P.; Harling, Leanne; Hughes-Hallett, Archie; Mayer, Erik; Najmaldin, Azad; Athanasiou, Thanos; Yang, Guang‐Zhong; Darzi, Ara

doi:10.1111/bju.12683

Cited by 122 publications

(84 citation statements)

References 35 publications

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“…For example, robot-assisted approaches have been associated with longer operating times for many procedure types 6 . A large proportion of these comparative studies, however, may have been generated from surgeons who were still learning the robotic technology in question 4 , potentially underestimating the full benefits of robotic assistance. Robot-assisted approaches have the potential to expedite surgeon learning, but methods used to measure and define learning curves seem inconsistent 1 .…”

Section: Introductionmentioning

confidence: 99%

Systematic review of learning curves in robot-assisted surgery

et al. 2020

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Background: Increased uptake of robotic surgery has led to interest in learning curves for robot-assisted procedures. Learning curves, however, are often poorly defined. This systematic review was conducted to identify the available evidence investigating surgeon learning curves in robot-assisted surgery.Methods: MEDLINE, Embase and the Cochrane Library were searched in February 2018, in accordance with PRISMA guidelines, alongside hand searches of key congresses and existing reviews. Eligible articles were those assessing learning curves associated with robot-assisted surgery in patients.Results: Searches identified 2316 records, of which 68 met the eligibility criteria, reporting on 68 unique studies. Of these, 49 assessed learning curves based on patient data across ten surgical specialties. All 49 were observational, largely single-arm (35 of 49, 71 per cent) and included few surgeons. Learning curves exhibited substantial heterogeneity, varying between procedures, studies and metrics. Standards of reporting were generally poor, with only 17 of 49 (35 per cent) quantifying previous experience. Methods used to assess the learning curve were heterogeneous, often lacking statistical validation and using ambiguous terminology.Conclusion: Learning curve estimates were subject to considerable uncertainty. Robust evidence was lacking, owing to limitations in study design, frequent reporting gaps and substantial heterogeneity in the methods used to assess learning curves. The opportunity remains for the establishment of optimal quantitative methods for the assessment of learning curves, to inform surgical training programmes and improve patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Systematic review of learning curves in robot-assisted surgery

et al. 2020

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“…In the largest multinational, multicenter comparison of pediatric minimally invasive pyeloplasty, Silay et al showed that the robotic cohort experienced shorter lengths of stay (2.1 days vs 4.6 days) and a lower postoperative complication rate (3.2% vs 7.7%) when compared with standard laparoscopy. 6 A shorter hospital stay was also observed when RP was compared with OP in a national assessment of USA children, and in a meta-analysis comparing RP, LP and OP by Cundy et al [7][8][9] Similar convalescence trends were observed in a national assessment of RUR, in addition to an overall increased prevalence of the technique from 2009 to 2012. 10 In order to actualize these benefits, it is critical to implement a well-structured plan.…”

Section: Introductionmentioning

confidence: 61%

“…In robotic pediatric urology, pyeloplasty is by far the most commonly carried out procedure. Many reports document outcomes similar to the gold standard open approach early on in adaptation, with multi‐institutional series and meta‐analysis also highlighting similar outcomes over longer periods of time . This makes pyeloplasty the obvious selection for an index case.…”

Section: Program Modelmentioning

confidence: 97%

Setting up a pediatric robotic urology program: A USA institution experience

et al. 2017

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Implementing a robotic urological surgery program requires institutional support, and necessitates a comprehensive, detail-oriented plan that accounts for training, oversight, cost and case volume. Given the prevalence of robotic surgery in adult urology, in many instances it might be feasible to implement a pediatric robotic urology program within the greater context of adult urology. This involves, from an institutional standpoint, proportional distribution of equipment cost and operating room time. However, the pediatric urology team primarily determines goals for volume expansion, operative case selection, resident training and surgical innovation within the specialty. In addition to the clinical model, a robust economic model that includes marketing must be present. This review specifically highlights these factors in relationship to establishing and maintaining a pediatric robotic urology program. In addition, we share our data involving robot use over the program's first nine years

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“…Ob in dieser Altersgruppe tatsächlich die Invasivität des endoskopischen Eingri es signi kant geringer ist als bei einer o enen Operation, die hier mit einem sehr kleinen Zugang auskommt, ist schwer messbar. Auf jeden Fall erzielen die o ene, die konventionell laparoskopische und die robotische Pyeloplastik vergleichbar gute perioperative und Langzeitergebnisse [10]. Endopyelotomien haben dagegen bei signi kant schlechteren Ergebnissen keinen Platz im primären Management der subpelvinen Stenose [11].…”

Section: Diagnostik Und Therapie Bei Subpelvinen Stenosenunclassified

Paradigmenwechsel in der therapeutischen Strategie

Conrad

2016

Uro-News

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Die europäischen Leitlinien sind konservativ ausgerichtet, zumindest, wenn es um den Therapiestandard bei Stenosen der Uretermündung geht. Ähnlich verhält es sich mit subpelvinen Stenosen. Hier lautet die Empfehlung, eine aktive Überwachung bei stabilen Verhältnissen der operativen Therapie vorzuziehen. Um zu entscheiden, wann letztere sinnvoll ist, sollte eine genaue Prognose der Folgen der Harntransportstörung erfolgen. D ilatationen des oberen Harntrakilatationen des oberen Harntrakilatationen des oberen Harntrak tes gehören zu den häu gsten angeborenen Fehlbildungen über-haupt. Dabei ist die Dilatation selbst nur ein Surrogat der zugrunde liegenden Pathologie. Diese kann nicht nur aus einer thologie. Diese kann nicht nur aus einer Harntransportstörung, sondern auch aus einem vesikoureteralen Re ux bestehen; seltener ist eine Kombination aus beiden Entitäten zu beobachten.Angeborene Harntransportstörungen führen nur in einem Teil der betro enen Nieren zu einer progredienten Funktionsverschlechterung. Diese Erkenntnis führte zu einem deutlichen Paradigmenwechsel von der regelmäßigen operati wechsel von der regelmäßigen operativen Behandlung hin zu einer aktiven Überwachung. Diejenigen Kinder zu identi zieren, die unbehandelt einen Funktionsverlust erleiden werden und daher einer operativen erapie bedür-fen, ist allerdings trotz jahrelanger Forschung und der relativen Häu gkeit des Krankheitsbildes immer noch schwierig. Prävalenz und Ursachen kongenitaler DilatationenBis in die frühen achtziger Jahre des letzten Jahrhunderts ging man von einer Prävalenz kongenital dilatierter oberer Harnwege von etwa 1/1.000 Neugeborenen aus. In den folgenden 15 Jahren wurde jedoch deutlich, dass kongenitale Harntraktdilatationen mindestens fünf, eher sogar zehnmal häu ger vorkommen. Grund für diesen Anstieg war nicht ein tatsächlich häu geres Au re nicht ein tatsächlich häu geres Au re--ten der zugrunde liegenden Ursachen, ten der zugrunde liegenden Ursachen, sondern die zunehmende und schließ--lich fast ächendeckende Anwendung des fetalen Ultraschalls bei der Schwan--© photos.com PLUS Deutlich höher als viele Jahre angenommen, liegt die Prävalenz für dilatierte Harnwege bei Neugeborenen weltweit bei mittlerweile 0,5 bis 1 %.

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Meta‐analysis of robot‐assisted vs conventional laparoscopic and open pyeloplasty in children

Cited by 122 publications

References 35 publications

Systematic review of learning curves in robot-assisted surgery

Systematic review of learning curves in robot-assisted surgery

Setting up a pediatric robotic urology program: A USA institution experience

Paradigmenwechsel in der therapeutischen Strategie

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