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Chen Z, Xu H, Wang C, Hu S, Ali M, Wang Y, Kai Z. Robot-assisted surgery versus laparoscopic surgery of ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Robot Surg 2023; 17:1891-1906. [PMID: 37310527 DOI: 10.1007/s11701-023-01648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
The clinical effectiveness and safety of robot-assisted laparoscopic pyeloplasty (RP) compared with laparoscopic pyeloplasty (LP) have not been clearly established in ureteropelvic junction obstruction (UPJO) children and require review. We searched in the Cochrane, MEDLINE, EMBASE, Web of Science, and CNKI database on 30 June 2022. This systematic review and meta-analysis were performed in RevMan 5.4 based on studies comparing RP versus LP in children with UPJO and subgroup analysis in children < 2 years of age has been performed. The Newcastle-Ottawa Scale was used to evaluate the studies. We included one RCT, and eighteen cohort studies, a total involving 3370 children. Compared with LP, RP showed higher surgical success rates (OR 2.57, 95%CI (1.24, 5.32), P < 0.05), lower postoperative complication rates (OR 0.61, 95%CI (0.38, 0.99), P < 0.05), shorter hospital stay (MD - 1.04, 95% CI (- 1.6, - 0.47), P < 0.05) as well as operative time (MD - 22.11, 95%CI (- 35.91, - 8.31), P < 0.05). No significant differences were detected for intraoperative complication rates or conversion to open surgery rates. RP is an alternative to UPJO with higher success rates, and less postoperative complications. Evidence on the effectiveness and safety of RP compared with LP for UPJO children is of low certainty. More quality evidence in the form of randomized controlled trials is needed to obtain more reliable analysis results.
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Affiliation(s)
- Zhuming Chen
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Huaiwen Xu
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Chaohui Wang
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Shuangjiu Hu
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Muhammad Ali
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yang Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhe Kai
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China.
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3
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Sun M, Yu C, Zhao J, Liu M, Liu Y, Han R, Chen L, Wu S. The efficacy of robotic-assisted laparoscopic pyeloplasty for pediatric ureteropelvic junction obstruction: a systematic review and meta-analysis. Pediatr Surg Int 2023; 39:265. [PMID: 37673951 DOI: 10.1007/s00383-023-05541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
To evaluate the safety and effectiveness of robotic-assisted laparoscopic pyeloplasty (RALP) for treating pediatric ureteropelvic junction obstruction through an extensive comparison of RALP, open pyeloplasty (OP) and laparoscopic pyeloplasty (LP). We conducted a comprehensive search of the following databases: PubMed, Excerpta Medica Database, Cochrane Library, Web of Science database, China National Knowledge Infrastructure, WanFang Data, and China Biology Medical Disc. Baseline data were compared, the sources of heterogeneity were assessed, and publication biases were detected. This study was registered with PROSPERO (CRD42023415667). 26 studies with 6074 cases performing pyeloplasty were included, and the overall data are comparable. Our analysis showed no significant difference in success rate and postoperative complications between RALP and OP, and RALP is associated with a shorter length of stay (LOS) (MD - 1.00 95%CI - 1.45 to - 0.55, p < 0.0001). In addition, compared to LP, RALP was associated with a shorter anastomosis time (MD - 18.35 95%CI - 29.88 to - 6.82, p = 0.002) and fewer postoperative analgesics (MD - 0.09 95% CI - 0.18 to - 0.01, p = 0.03); however, RALP has a longer operative time (OT) (MD 52.39, 95% CI 39.75-65.03, p < 0.00001) and higher cost. The heterogeneity of OT may be influenced by factors, such as age and region, while the heterogeneity of LOS primarily stems from regional differences. No significant publication bias was detected. Our meta-analysis shows that RALP can be an alternative to OP and LP with a high success rate, minimal postoperative complications, and shorter LOS. In addition, RALP contributes to reduce anastomosis time and postoperative analgesic drugs. However, further well-designed, large-scale, randomized controlled trials with additional parameters are needed to conduct a more comprehensive analysis of heterogeneity.
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Affiliation(s)
- Miao Sun
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Chengjun Yu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Jie Zhao
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Maolin Liu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Yan Liu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Rong Han
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Long Chen
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China
| | - Shengde Wu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China.
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China.
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4
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Esposito C, Cerulo M, Lepore B, Coppola V, D'Auria D, Esposito G, Carulli R, Del Conte F, Escolino M. Robotic-assisted pyeloplasty in children: a systematic review of the literature. J Robot Surg 2023:10.1007/s11701-023-01559-1. [PMID: 36913057 PMCID: PMC10374693 DOI: 10.1007/s11701-023-01559-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023]
Abstract
Robotic pyeloplasty has become a natural progression from the development of open, then laparoscopic procedures to treat pediatric patients with ureteropelvic junction obstruction (UPJO). Robotic-assisted pyeloplasty (RALP) is now considered a new gold standard in pediatric MIS. A systematic review of the literature retrieved from PubMed and published in the last 10 years (2012-2022) was performed. This review underlines that in all children except the smallest infants, where the open procedure has benefits in terms of duration of general anesthetic and there are limitations in the size of instruments, robotic pyeloplasty is becoming the preferred procedure to perform in patients with UPJO. Results for the robotic approach are extremely promising, with shorter operative times than laparoscopy and equal success rates, length of stay and complications. In case of redo pyeloplasty, RALP is easier to perform than other open or MIS procedures. By 2009, robotic surgery became the most used modality to treat all UPJO and continues to grow in popularity. Robot-assisted laparoscopic pyeloplasty in children is safe and effective with excellent outcomes, even in redo pyeloplasty or challenging anatomical cases. Moreover, robotic approach shortens the learning curve for junior surgeons, who can readily achieve levels of expertise comparable to senior practitioners. However, there are still concerns regarding the cost associated with this procedure. Further high-quality prospective observational studies and clinical trials, as well as new technologies specific for the pediatric population, are advisable for RALP to reach the level of gold standard.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy.
| | - Mariapina Cerulo
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Benedetta Lepore
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Coppola
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Daniela D'Auria
- Faculty of Computer Science, Free University of Bolzano, Bolzano, Italy
| | - Giorgia Esposito
- Internal Medicine Unit, University of Naples "Federico II", Naples, Italy
| | - Roberto Carulli
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Fulvia Del Conte
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
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7
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Andolfi C, Lombardo AM, Aizen J, Recabal X, Walker JP, Barashi NS, Reed F, Lopez PJ, Wilcox DT, Gundeti MS. 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. World J Urol 2022; 40:1049-1056. [PMID: 35044490 DOI: 10.1007/s00345-022-03929-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 01/04/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been widely adopted. However, little has been published detailing the learning curve of MIS, especially in infants. OBJECTIVE To quantify the learning curve of laparoscopic (LP) and robot-assisted laparoscopic pyeloplasty (RAL-P) for treatment of uretero-pelvic junction obstruction (UPJO) in infants evidenced by number of cases, operative time, success and complications. PATIENTS AND METHODS Between 2009 and 2017, we retrospectively reviewed pyeloplasty cases for treatment of UPJO in infants at three academic institutions. The primary outcome was success. Secondary outcomes were UPJO recurrence, complications, and operative time as a surrogate of skill acquisition. Continuous variables were analyzed by t test, Welch-test, and one-way ANOVA. Non-continuous variables were analyzed by Chi-squared test or Fisher's exact test. Learning curves (LC) were studied by r-to-z transformation and CUSUM. RESULTS Thirty-nine OP, 26 LP, and 39 RAL-P had mean operative times (OT) of 106, 121, and 151 min, respectively. LCs showed plateau in OT after 18 and 13 cases for LP and RAL-P, respectively. RAL-P showed a second phase of further improvements after 37 cases. At 16 months follow-up, there were similar rates of success and complications between the three groups. CONCLUSIONS Despite different duration of learning phases, proficiency was achieved in both LP and RAL-P as evidenced by stabilization of operative time and similar success rates and complications to OP. Before and after achievement of proficiency, LP and RAL-P can be safely learned and implemented for treatment of UPJO in infants.
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Affiliation(s)
- C Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Division of Biological Sciences and Pritzker School of Medicine, 5841 S. Maryland Ave, Rm J-664, Chicago, IL, 60637, USA
| | - A M Lombardo
- The University of Chicago Division of Biological Sciences and Pritzker School of Medicine, Chicago, IL, USA
| | - J Aizen
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Division of Biological Sciences and Pritzker School of Medicine, 5841 S. Maryland Ave, Rm J-664, Chicago, IL, 60637, USA
| | - X Recabal
- Pediatric Urology, Section of Urology, Department of Surgery, Hospital Exequiel González Cortés & Clínica Alemana, Santiago, Chile
| | - J P Walker
- Pediatric Urology, Section of Urology, Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - N S Barashi
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Division of Biological Sciences and Pritzker School of Medicine, 5841 S. Maryland Ave, Rm J-664, Chicago, IL, 60637, USA
| | - F Reed
- Pediatric Urology, Section of Urology, Department of Surgery, Hospital Exequiel González Cortés & Clínica Alemana, Santiago, Chile
| | - P J Lopez
- Pediatric Urology, Section of Urology, Department of Surgery, Hospital Exequiel González Cortés & Clínica Alemana, Santiago, Chile
| | - D T Wilcox
- Pediatric Urology, Section of Urology, Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - M S Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Division of Biological Sciences and Pritzker School of Medicine, 5841 S. Maryland Ave, Rm J-664, Chicago, IL, 60637, USA.
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