Searching for the Least Invasive Management of Pelvi-Ureteric Junction Obstruction in Children: A Critical Literature Review of Comparative Outcomes

Abstract

Introduction: To review the published evidence on the minimally invasive pyeloplasty techniques available currently with particular emphasis on the comparative data about the various minimally invasive alternatives to treat pelvi-ureteric junction obstruction and gauge if one should be favored under certain circumstances. Materials and Methods: Non-systematic review of literature on open and minimally invasive pyeloplasty including various kinds of laparoscopic procedures, the robotic-assisted laparoscopic pyeloplasty, and endourological procedures. Results: Any particular minimally invasive pyeloplasty procedure seems feasible in experienced hands, irrespective of age including infants. Comparative data suggest that the robotic-assisted procedure has gained wider acceptance mainly because it is ergonomically more suited to surgeon well-being and facilitates advanced skills with dexterity thanks to 7 degrees of freedom. However, costs remain the major drawback of robotic surgery. In young children and infants, instead, open surgery can be performed via a relatively small incision and quicker time frame. Conclusions: The best approach for pyeloplasty is still a matter of debate. The robotic approach has gained increasing acceptance over the last years with major advantages of the surgeon well-being and ergonomics and the ease of suturing. Evidence, however, may favor the use of open surgery in infancy.

First Pediatric Pyeloplasty Using the Senhance® Robotic System—A Case Report

“…Costs of robot-assisted surgical procedures are in general higher than in regular laparoscopic surgery, due to investment and maintenance costs of the robot. In a critical literature review of comparative outcomes reported for the least invasive management of ureteropelvic obstruction in children, a Spanish group found two major drawbacks of robotic-assisted laparoscopic pyeloplasty in children: costs and the size of instruments [20]. This might be true for the Da Vinci robotic system.…”

ERAS Improves Postoperative Recovery in Children

“…Robot-assisted laparoscopic surgery was first developed for use in adult patients but is now also applied in pediatric surgery. Robot-assisted laparoscopic surgery is well suited to operations that require fine dissection or suturing in small anatomic spaces [7] and has been used successfully in the management of pediatric hydronephrosis [8,9]. However, the operation requires extensive preparation of the gastrointestinal tract, use of the Trendelenburg position and a CO2 pneumoperitoneum, and surgery is associated with non-negligible risks of perioperative pneumoperitoneum-related complications, hypothermia, pressure injury, and scald injury.…”

Pre and postoperative imaging in patients undergoing pyeloplasty: A survey of current adult and paediatric practice

“…Pyelo-ureteral junction obstruction (PUJO) is a common condition in children and adults alike and pyeloplasty the standard treatment. 1–3…”

“…Pyelo-ureteral junction obstruction (PUJO) is a common condition in children and adults alike and pyeloplasty the standard treatment. [1][2][3] Usually, the first sign of PUJO is the radiological detection of hydronephrosis (HN) on an ultrasound (US) scan. HN is a very common finding in general.…”