Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy?

Andolfi, Ciro; Adamic, Brittany; Oommen, Jerry; Gundeti, Mohan S.

doi:10.1007/s00345-019-02943-z

Cited by 46 publications

(20 citation statements)

References 48 publications

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“…33 More recently, two authors have evaluated the same outcomes confronting LP vs RALP. According to Andolfi et al 34 results, success rates were comparable between the two minimally invasive approaches with average rates of 98.5% and 96.9% at a follow-up of 14.1 and 26.3 months for RALP and LP, respectively. RALP favoured lower complication rates as compared to LP, with a combined rate of 7.2% in the RALP group vs 14.3% in the LP group.…”

Section: Perioperative Paediatric Outcomesmentioning

confidence: 89%

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Mantica¹,

Ambrosini²,

Parodi³

et al. 2020

RRU

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Pyeloplasty is considered the gold standard for the management of ureteropelvic junction obstruction in cases of flank pain, recurrent stone formation or infection, and deteriorating renal function. Over the last two decades, minimally invasive techniques such as robotic (RALP) and laparoscopic pyeloplasty (LP) have become increasingly popular and have been moderately replacing the open approach. This paper aims to provide a comprehensive up-to-date review on safety, efficacy and outcomes regarding robotic repair of UPJO compared to the conventional laparoscopic procedure. RALP represents a viable and innovative alternative to conventional LP with a comparable success and complication rate both in adult and in paediatric fields. The robotic approach seems to add further technical advantages when compared to conventional LP but sustains a higher costs. Currently, the choice to adopt one of the different minimally invasive approaches depends on the surgeon’s preference or experience, and on institutional availability.

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Section: Perioperative Paediatric Outcomesmentioning

confidence: 89%

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Mantica¹,

Ambrosini²,

Parodi³

et al. 2020

RRU

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“…Robotic surgery in paediatric urology has been gained popularity since its introduction almost two decades ago, as it allows three-dimensional imaging, reduces surgeon's tremor and involuntary movements and consents a more ergonomic position for the surgeon. As reported by several studies, robotic-assisted pyeloplasty is the most common procedure performed in paediatric urology [32,33].…”

Section: Discussionmentioning

confidence: 99%

Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience

et al. 2020

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Purpose Uretero-pelvic junction obstruction is the most common cause of prenatal hydronephrosis. It can be intrinsic, extrinsic due to crossing vessel (CV) or mixed. This paper aims to present the surgical outcome in a single pediatric thirdlevel center. Methods A retrospective analysis of all children operated between 2011 and 2018 was conducted. Demographic information, pre-operative pelvic antero-posterior diameter (APD), intra-operative parameters, hospital stay and follow-up were considered. Re-do operations and success rate for Vascular Hitch (VH), open and laparoscopic pyeloplasties were recorded. Results 128 patients were included. The mean pre-operative APD was 30 mm. The etiology was intrinsic in 71.9%, extrinsic in 25.0% and mixed in 3.1%. The median age between intrinsic and extrinsic groups was statistically different. Thirty-one VH, 88 dismembered and 9 non-dismembered pyeloplasties were performed. The median hospital stay was 2 days for VH and 6 for pyeloplasties. The median hospital stay was statistically longer in open pyeloplasties compared to laparoscopic. The mean post-operative APD was 14 mm. The success rate after VH was 90.3%, after open pyeloplasties 97.9% and after mini-invasive pyeloplasties 91.8%. Conclusions VH could be a good option in the treatment of hydronephrosis due to CV, laparoscopic pyeloplasties have equivalent success rate and shorter hospital stay than open pyeloplasties.

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“…Concern has been raised whether the failure rate of LP could be higher in infants than in older children ( 21 ). A recent systematic review found an average success rate of 96.9% for LP in children ( 4 ). The authors, however, reported that there were very few studies targeted at infants ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…The contemporary evidence of performing pyeloplasty by minimally invasive approach in the infant population, however, are less robust than in older children as there are few comparative studies ever published (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies of meta-analysis have shown that both laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) are viable options to treat ureteropelvic junction (UPJ) obstruction in children with the benefits of shorter hospital stay and decreased morbidity while maintaining a success rate comparable to open pyeloplasty (OP) ( 1 – 3 ). The contemporary evidence of performing pyeloplasty by minimally invasive approach in the infant population, however, are less robust than in older children as there are few comparative studies ever published ( 4 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparing Robot-Assisted Laparoscopic Pyeloplasty vs. Laparoscopic Pyeloplasty in Infants Aged 12 Months or Less

2021

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Objective: To investigate the outcomes of minimally invasive approach to infants with ureteropelvic junction (UPJ) obstruction by comparing the two surgical modalities of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP).Methods: We conducted a retrospective review of all consecutive infants aged ≤12 months who underwent either LP or RALP in a single institution over the period of 2008–Jul 2020. We included primary pyeloplasty cases that were performed by or under the supervision of the same surgeon.Results: Forty-six infants (LP = 22; RALP = 24) were included with medians of age and body weight at 6 months (2–12months) and 8.0 kg (5.4–10 kg), respectively. There was no difference between the two groups in the patients' demographics and pre-operative characteristics. All infants underwent LP or RALP successfully without conversion to open surgery. None had intraoperative complications. Operative time (OT) was 242 min (SD = 59) in LP, compared with 225 min (SD = 39) of RALP (p = 0.25). Linear regression analysis showed a significant trend of decrease in OT with increasing case experience of RALP(p = 0.005). No difference was noted in the post-operative analgesic requirement. RALP was associated with a shorter hospital length of stay than LP (3 vs. 3.8 days; p = 0.009). 4/22(18%) LP and 3/24(13%) RALP developed post-operative complications (p = 0.59), mostly minor and stent-related. The success rates were 20/22 (91%) in LP and 23/24 (96%) in RALP (p = 0.49).Conclusions: Pyeloplasty by minimally invasive approach is safe and effective in the infant population. RALP may have superiority over LP in infants with its faster recovery and a more manageable learning curve to acquire the skills.

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Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy?

Cited by 46 publications

References 48 publications

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience

Comparing Robot-Assisted Laparoscopic Pyeloplasty vs. Laparoscopic Pyeloplasty in Infants Aged 12 Months or Less

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