Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO)

Abstract

Introduction: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. Material and Methods: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. Results: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. Conclusions: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

Minimally invasive surgery for pyeloplasty poised to become The preferred surgical technique irrespective of age

“…Finally, providing a benefit from the cosmetic endpoint can also lead to it becoming the preferable approach. By using a multi-institutional approach, with a large number of patients, the present study highlighted the main reasons why the minimally invasive is becoming the preferable option to perform a pyeloplasty (1). This study showed that the MIS approach both laparoscopically and robotically achieved similar success and complication rates but provided a benefit in the recovery with a shorter hospital length of stay.…”

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children

“…Fourth, robotic surgery has better ergonomics that helps alleviate the fatigue of surgeons during surgery. Fifth, performing the refined operation in a limited space reduces secondary injuries ( 6 , 14 – 17 ). Finally, the learning curve of robot surgery is short, and is significantly shorter in surgeons with considerable LP experience.…”

Efficacy of laparoscopic pyeloplasty for pediatric hydronephrosis caused by symptomatic versus asymptomatic endogenous ureteropelvic junction obstruction: a retrospective analysis

“… 16 The success rate and recurrence rate of LP are similar to those of open pyeloplasty. 17 The advantages of LP include reduced pain, a shorter hospital stay, and a better cosmetic effect on the abdominal wall. 16 The treatment decision for UPJO was historically based on clinical symptoms and auxiliary examination results.…”