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Nguyen QT, Nguyen TM, Le DA, Nguyen LVM, Dang TT, Nguyen SH, Nguyen VHK, Nguyen LT. Long-term outcome of retroperitoneoscopic one-trocar-assisted pyeloplasty: a single-center and single-surgeon experience. Int Urol Nephrol 2024:10.1007/s11255-024-04091-9. [PMID: 38797767 DOI: 10.1007/s11255-024-04091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The aim of this study was to assess the long-term outcomes of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) for ureteropelvic junction obstruction (UPJO) in children. METHODS This retrospective analysis included 70 pediatric cases, all under the age of 5, diagnosed with UPJO and treated with the OTAP technique between May 2011 and June 2013 by a single surgeon. A single 10 mm operative scope with a 5 mm working channel was utilized to mobilize the ureteropelvic junction (UPJ) and exteriorize it through the trocar insertion site. Subsequently, conventional Anderson-Hynes dismembered pyeloplasty was conducted extracorporeally. Patient's demographics, operative time, hospital stay, complications, and success rate were evaluated. RESULTS Seventy pediatric patients (65 males and 5 females) underwent OTAP, with ages at the time of operation ranging from 1 month to 5 years (mean = 22.6 ± 18.6 months). The mean operative time was 74.8 ± 15.2 min. There was a significant reduction in the mean renal pelvis size from 34.3 ± 8.1 mm preoperatively to 13.8 ± 4.7 mm postoperatively (p < 0.05). Moreover, the mean differential renal function (DRF) increased from 47.9 ± 9.8% preoperatively to 51.2 ± 5.9% postoperatively (p < 0.05). All patients experienced an uneventful postoperative recovery, with a median hospital stay of 3.4 days. The success rate was 95.7%, with a median follow-up time of 75 months (range: 6-125 months). CONCLUSION OTAP is a safe and feasible minimally invasive technique to correct ureteropelvic junction obstruction in children. It could be considered as a treatment of choice for children under the age of 5 as it combines the advantages of open and retroperitoneoscopic pyeloplasty and presents excellent long-term outcomes. TRIAL REGISTRATION NUMBER NCT06349161 April 4th, 2024, retrospectively registered.
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Affiliation(s)
- Quang Thanh Nguyen
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
- College of Health Science, VinUniversity, Hanoi, Vietnam
| | - Thuy Mai Nguyen
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
| | - Dung Anh Le
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
| | | | - Trang Thu Dang
- College of Health Science, VinUniversity, Hanoi, Vietnam
| | | | | | - Liem Thanh Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Health Care System, Vinmec Times City, Minh Khai, Hanoi, Vietnam.
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Ortiz-Seller D, Panach-Navarrete J, Valls-González L, Martínez-Jabaloyas JM. Comparison between open and minimally invasive pyeloplasty in infants: A systematic review and meta-analysis. J Pediatr Urol 2024; 20:244-252. [PMID: 38065760 DOI: 10.1016/j.jpurol.2023.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is the most common cause of congenital hydronephrosis. Techniques such as laparoscopic pyeloplasty (LP) have gained in popularity over recent years. Although some retrospective studies have compared minimally invasive reconstructive techniques with open surgery for treatment of UPJO in infants, results remain controversial due to the small sample size in most of these studies. OBJECTIVE To verify whether the benefits of minimally invasive pyeloplasty (MIP) observed in adults and children over 2 years of age also apply to infants. METHODS A systematic review of the literature was performed according to PRISMA recommendations. We searched databases of MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. We excluded studies in which patient cohorts were outside the age range between 1 and 23 months of age (infants). Studies should evaluate at least one of the following outcomes: average hospital stay, operative time, follow-up time, complications, post-surgical catheter use, success rate and reintervention rate. The quality of the evidence was assessed with the ROBINS-I tool. RESULTS In total, 13 studies were selected. 3494 patients were included in the meta-analysis, of whom 3054 underwent OP, while the remaining 440 were part of the group undergoing MIP. The mean difference in hospital days was -1.16 lower the MIP group (95 % CI; -1.78, -0.53; p = 0.0003). Also, our analysis showed a significantly shorter surgical time in the group who underwent OP, with a mean operative time of 119.92 min, compared to 137.63 min in the MIP group (95 % CI; -31.76, -6.27; p = 0.003). No statistically significant between-group differences were found respect to follow-up time, complications, post-surgical catheter use, success rate and reintervention rate. CONCLUSION This systematic review with meta-analysis has shown that laparoscopic/robotic pyeloplasty in infants is a safe technique with similar success rates to open surgery. Nonetheless, randomized clinical trials with longer follow-up are needed to consolidate these results with more robust scientific evidence.
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Affiliation(s)
- Daniel Ortiz-Seller
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain.
| | - Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
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Wang X, Li J, Fan S, Li Z, Yang Z, Liu P, Song H, Zhang W. Failure in Double-J stent inserting in laparoscopic pyeloplasty of ureteropelvic junction obstruction: the clinical features and outcomes. BMC Urol 2023; 23:192. [PMID: 37980482 PMCID: PMC10657558 DOI: 10.1186/s12894-023-01359-7] [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: 01/12/2023] [Accepted: 04/26/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Double-J (DJ) stent placement is an important procedure during laparoscopic pyeloplasty (LP). Failing to insert the DJ stent may indicate the patient was also complicated with uretero-vesical junction obstruction (UVJO), and surgeons have to change to another alternative drainage method. In the present study, we analyzed the risk factors of failure of DJ stent placement during the LP and reviewed the clinical outcomes of these challenging pyeloplasties. METHODS We retrospectively analyzed the clinical data of patients with ureteropelvic junction obstruction (UPJO) who underwent LP in our department from January 2016 to September 2020. For patients who developed a difficult process of inserting the DJ stent, the externalized uretero-pyelostomy (EUP) stent was indwelled. Patients were finally divided into two groups: DJ group and EUP group. The primary outcomes were recurrent UPJO, postoperative uretero-vesical junction obstruction (UVJO) and complications. RESULTS A total of 535 patients were included in the study, of which 37 patients (6.9%) failed to insert the DJ stent. Age was younger, and weight was lower (P < 0.05) in the EUP group. Within follow-up, recurrent UPJO occurred in ten (1.87%) patients, nine in the DJ group and one in the EUP group (P > 0.05). The incidence of postoperative UVJO in the EUP group was significantly higher than in the DJ group (10.8% vs. 0.2%, P < 0.01). 74 patients (13.8%) developed complications after surgery, 12 patients (32.4%) in the EUP group, significantly higher than that in the DJ group (32.4% vs. 12.4%, P < 0.01). Compared with the DJ group, the larger APD were observed in the EUP group at three months postoperatively (3.50 [3.02;4.58] vs. 2.20 [1.50;2.88], P < 0.05), but the difference vanished in further follow-up. CONCLUSION The failure of DJ stent placement tends to occur in patients with younger age, lower weight, and larger preoperative APD. Failure may not increase the recurrent UPJO rate, but may indicate a higher probability of postoperative UVJO and may develop more postoperative complications and slower recovery.
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Affiliation(s)
- Xinyu Wang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Jiayi Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Songqiao Fan
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Zonghan Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Zhenzhen Yang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
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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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Reed F, Recabal X, Echeverría P, Braga LH, Cherian A, Gatti JM, Garcia-Aparicio L, Perez-Bertolez S, de Badiola F, Bujons A, Moldes JM, Mushtaq I, López PJ. Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study. World J Urol 2023; 41:1675-1679. [PMID: 36947174 DOI: 10.1007/s00345-023-04359-2] [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: 09/15/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications. MATERIALS AND METHODS This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed. RESULTS Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy. CONCLUSION Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.
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Affiliation(s)
- Francisco Reed
- Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile.
- Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clínica Alemana, Universidad de Chile, Av Gran Avenida 3300, San Miguel, Santiago, Chile.
| | | | | | | | | | | | | | | | | | | | | | | | - Pedro-José López
- Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile
- McMaster University, Hamilton, Canada
- Great Ormond Street Hospital, London, England
- Children's Mercy Hospital, Kansa City, MO, USA
- Hospital Saint Joan de Deu, Barcelona, Spain
- Hospital Italiano, Buenos Aires, Argentina
- Fundación Puigvert, Barcelona, Spain
- Facultad Medicina, Servicio Pediatria y Cirugia Infantil, Universidad de Chile, Santiago, Chile
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Hornok Z, Ferencz A, Kubiak R, Cserni T. Cheap and clean dry balloon training model for laparoscopic pyeloplasty. J Pediatr Urol 2023:S1477-5131(23)00116-X. [PMID: 37037762 DOI: 10.1016/j.jpurol.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
Simulation-based training (SBT) has a significant role in training in complex procedure like laparoscopic pyeloplasty. We propose a new training model for laparoscopic pyeloplasty which has been compared to other models. Trainees (n = 22) evaluated our balloon model (BM) and three other models -glove finger model (GFM), chicken thigh model (ChTM) and chicken crop model (ChCrM)- subjectively, based on a 5-point Likert scale. The face validity mean score of our BM model was 3.58 ± 0.69. Our novel model can be a cost-effective, hygienic, and easy-access alternative to other laparoscopic pyeloplasty models.
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Affiliation(s)
- Zita Hornok
- Department of Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Bethesda Children's Hospital, Budapest, Hungary.
| | - Andrea Ferencz
- Department of Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rainer Kubiak
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, CH-9000 Sankt Gallen, Switzerland
| | - Tamas Cserni
- Department of Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Royal Manchester Children's University Hospital, Manchester University NHS Foundation Trust, United Kingdom
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Fathi BA, Elgammal AA, Abouelgreed TA, Ghoneimy OM, Abdrabuh AM, Hindawy MA, Aboelsaad AY, Deif H, Mahmoud A. Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study. Arch Ital Urol Androl 2023; 95:11231. [PMID: 36943001 DOI: 10.4081/aiua.2023.11231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Uretero-pelvic junction obstruction is the most common form of congenital anomaly of the kidney and urinary tract with an incidence of about 1/1.000-1.500 of births and the aetiology and pathogenesis of this anomaly are still unclear until now. METHODS This is a prospective randomized comparative study conducted from March 2022 to December 2022. Thirty children with uretero-pelvic junction obstruction were included and randomly divided into two groups according to a 1:1 ratio (computer-generated randomization, single blind). Fifteen cases (12 males and 3 female) were subjected to ureter first approach pyeloplasty, and another fifteen (9 males and 6 female) were subjected to conventional Anderson Hynes pyeloplasty. RESULTS The mean age of all patients was 6.7 ± 5.4 years in ureter first approach group and 5.1 ± 4.3 years in conventional Anderson-Hynes pyeloplasty group. There were no significant differences between the two groups regarding age, gender, presentation, side, preoperative renogram and post-operative renogram. Also, there were no significant differences between the two groups regarding operative time (in first group 110.3 ± 12.4 and in the second group 111.2 ± 12.0 with p < 0.836), pre and post-operative complication rate. Two cases of urinary tract infections in the first group, one of them having fever, and four cases in the second group, two of them having fever (p < 0.651); four cases of loin pain in the first group and one case in the second group (p < 0.330); one case in the first group having pro- longed leakage of urine for 7 days in post-operative period (p < 0.309). However GFR and t 1⁄2 improved significantly after operation in both groups (p < 0.001). CONCLUSIONS Ureter first approach is a simple and effective procedure in children with good short term outcomes and could be done safely especially for beginners and less expert surgeons. Finally, it can overcome the problem of long ureteric stricture that may be found intraoperatively because you can shift easily to a flap procedure and complete a tension free anastomosis.
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Affiliation(s)
- Basem A Fathi
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Ahmed A Elgammal
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Osama M Ghoneimy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Mohamed A Hindawy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Ahmed Y Aboelsaad
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Hazem Deif
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Alaa Mahmoud
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
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Neheman A, Sabler IM, Beberashvili I, Goltsman G, Verchovsky G, Kord E, Yossepowitch O, Zisman A, Stav K. Ureteral Stent Colonization and Urinary Tract Infection in Children Undergoing Minimally Invasive Pyeloplasty. Eur J Pediatr Surg 2023; 33:47-52. [PMID: 35858642 DOI: 10.1055/a-1905-4460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Minimally invasive pyeloplasty (MIP), namely, laparoscopic and robot-assisted interventions, has gained popularity in recent years. Double-J ureteral stents are frequently inserted during surgery. Foreign bodies in the urinary tract are considered as risk factor for developing urinary tract infection (UTI). This study aimed to specify the bacteria cultured from urine and stents responsible for UTI in children with indwelling ureteral stents undergoing MIP. PATIENTS AND METHODS We retrospectively reviewed medical records of 30 children (22 boys and 8 girls) who had undergone MIP between 2014 and 2017. Median age at surgery was 2.7 years (interquartile range [IQR]: 0.5-7.9). Urine cultures were obtained before surgery, before stent removal, 1 month after stent removal, and if UTI was suspected. Stents were removed 4 to 8 weeks after surgery and cultured. Patients' demographics, types of stents, and surgical details were recorded. RESULTS Median stent indwelling time was 5.09 weeks (IQR: 4-6). Postoperative febrile UTI developed in 4/30 (13%) patients. Afebrile UTI occurred in another 4/30 (13%) patients. Stent cultures were positive in 19/30 (63%) patients. Stent and urinary cultures were identical in only one patient. Three of four patients with preoperative asymptomatic bacteriuria developed postoperative UTI. There was no association between UTI, gender, stent diameter, and duration of indwelling catheter. CONCLUSION After MIP, febrile UTI and afebrile UTI occurred in about one quarter of patients. Pathogens isolated postsurgically from urinary cultures were unrelated to those colonizing the stents. Therefore, routine stent culturing is of low clinical significance. Moreover, small-caliber stents and longer indwelling periods were not risk factors for UTI. Optimizing antibiotic treatment for children with preoperative UTI may potentially prevent morbidity after surgery.
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Affiliation(s)
- Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel.,Department of Infectious Diseases, Shamir Medical Center, Zerifin, Israel
| | - Itay M Sabler
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | | | - Galina Goltsman
- Department of Infectious Diseases, Shamir Medical Center, Zerifin, Israel
| | - Guy Verchovsky
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Eyal Kord
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Orit Yossepowitch
- Infectious Disease Unit, Edith Wolfson Medical Center, Holon, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center, Zerifin, Israel
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Liu P, Li J, Fan S, Li Z, Yang Z, Wang X, Song H, Zhang W. Febrile urinary tract infection after Double-J stent removal is associated with restenosis after laparoscopic pyeloplasty: A propensity score matched analysis of 503 children. J Pediatr Urol 2022; 19:200.e1-200.e7. [PMID: 36599720 DOI: 10.1016/j.jpurol.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze the association between the febrile urinary tract infection (fUTI) after Double-J (DJ) stents removal and restenosis after laparoscopic pyeloplasty (LP). STUDY DESIGN We retrospectively reviewed the clinical data of patients who were treated with transperitoneal LP for ureteropelvic junction obstruction from 2016 to 2020. Patients were divided into two groups according to whether they developed fUTI after DJ stent removal within 48 h. The 1:3 Propensity Score Matched (PSM) method was used to balance confounding variables. RESULTS 503 patients were included in the study. 28 (5.57%) patients developed fUTI after DJ stent removal. Compared with the non-fUTI group, age was younger, and weight was lower (P < 0.05) in the fUTI group. Restenosis occurred in 11 (2.2%) patients, of which six patients developed fUTI after DJ stent removal. The revision surgery rate in the fUTI group was significantly higher than in the non-fUTI group (21.4% vs. 1.1%, P < 0.01). After PSM, the results remained consistent. For 492 patients without restenosis, 22 patients developed fUTI. Compared with the non-fUTI group, the larger anteroposterior diameter (APD) and higher APD/cortical thickness (P/C) ratio were observed in the fUTI group at three months and six months postoperatively (P < 0.05), but the difference vanished at 12 months and 24 months after surgery (Figure). DISCUSSION FUTI after DJ stent removal is not uncommon after LP, and surgeons are often concerned about the possibility of restenosis. In the present study, although our results demonstrated a significant association between them, restenosis patients comprise only about 20% of fUTI patients. Based on our clinical observations, fUTI is often developed in children from 1 to 6 years of age, and the younger patients may be afraid of voiding because of the postoperative pain after DJ stent removal. Besides, intraoperative manipulation of DJ stent removal may lead to transient edema in the anastomotic site, causing the fUTI. For patients who develop fUTI after DJ stent removal but without persistent symptoms, the transient worsening of hydronephrosis during the early postoperative period may not impact long-term outcomes (As shown in Figure). Additional follow-up is needed to prevent the deterioration of renal function. CONCLUSIONS Our result demonstrated that fUTI after DJ stent removal is associated with restenosis after LP. For fUTI patients without restenosis, APD and P/C ratio exhibited transient worsening at three months and six months postoperatively, decreasing gradually during follow-up. Patients who develop fUTI after DJ stent removal should be monitored.
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Affiliation(s)
- Pei Liu
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jiayi Li
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Songqiao Fan
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zonghan Li
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhenzhen Yang
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xinyu Wang
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongcheng Song
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Weiping Zhang
- Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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González ST, Rosito TE, Tur AB, Ruiz J, Gozalbez R, Maiolo A, Tavares PM, Gorgen ARH, Kencht ELD, Madarriaga YQ, Weller S, Tobia IP, Castellan M, Corbetta JP. Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO). Int Braz J Urol 2022; 48:961-968. [DOI: 10.1590/s1677-5538.ibju.2022.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sebastian Tobía González
- Universidad Nacional de la Plata, Argentina; Hospital Interzonal Especializado en Pediatría “Sor María Ludovica”, Argentina
| | - Tiago E. Rosito
- Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
| | | | | | | | - Anabella Maiolo
- Hospital Interzonal Especializado en Pediatría “Sor María Ludovica”, Argentina
| | - Patric M. Tavares
- Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
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Fan S, Xiong S, Li Z, Yang K, Wang J, Han G, Li X, Chen S, Yuan C, Meng C, Dai X, Mu L, Li X, Zhou L. Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results. J Endourol 2022; 36:1538-1544. [PMID: 35864812 DOI: 10.1089/end.2022.0366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.
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Affiliation(s)
- Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Changwei Yuan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiaofei Dai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Li Mu
- Department of Operation Room, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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12
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Schäfer FM, Stehr M. Nierenfunktion nach Pyeloplastik im Langzeitverlauf. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Kommentar zu Kosmetik nach offener, laparoskopischer und Roboter-assistierter Pyeloplastik. Aktuelle Urol 2022; 53:390-391. [DOI: 10.1055/a-1860-7330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Zu'bi F, O'Kelly F, Farhat WA, Chua M, Shiff M, Gao B, Kim JK, Kutbi RA, Pokarowski M, Koyle MA. Recurrent UPJ obstruction following paediatric pyeloplasty is associated with an initial <2.5cm incision open surgical approach. Urology 2022:S0090-4295(22)00721-X. [PMID: 36002089 DOI: 10.1016/j.urology.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/12/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the risk factors that affect surgical outcomes for pediatric pyeloplasty, and whether this may be related to the choice of operative approach. METHODS A retrospective cohort study was performed to evaluate clinicodemographic and operative characteristics of children undergoing dismemberment pyeloplasty by 2 senior pediatric urologists in our tertiary institution between Jan 2008 - Dec 2017. Outcomes included overall complications, re-stenosis, and revision pyeloplasty based on clinic-radiological parameters. Bivariate analysis with Chi-square and Mann-Whitney U test followed by multivariate logistic regression with backward likelihood analysis determined an adjusted effect estimate of the identified significant indicators for inferior peri-operative outcomes related to management. RESULTS A total of 185 (93 open, 92 Laparoscopic) cases with an average follow-up of 31.3±27.4 months were analyzed. Complications occurred in 21 (11.4%) patients. 12 (6.5%) experienced recurrent UPJ obstruction with 10 (5.4%) undergoing redo-pyeloplasty. Of these, 9 were performed open and 1 laparoscopically. Multivariate logistic regression identified open pyeloplasty as an independent predictor for overall complications (HR 3.29, 95%CI 1.14, 9.51), recurrent UPJ obstruction (HR 49.8, 95%CI 3.09, 803.2) and redo-pyeloplasty (HR 9.75, 95%CI 1.21, 78.6) compared to a laparoscopic approach. Missed crossing vessels were identified in seven redo-cases, which all were from prior open pyeloplasty. CONCLUSIONS An initial open approach was identified as an independent predictor of future complications due to a higher incidence missed crossing vessels at initial repair. Surgeons need to remain especially mindful of this phenomenon when working in a confined open field.
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Affiliation(s)
- Fadi Zu'bi
- Department of Urology, Rambam Health Care Campus, Haifa, Israel; Department of Urology, The Nazareth Hospital EMMS, Nazareth, Israel.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, Royal College of Surgeons in Ireland & University College Dublin, Ireland.
| | - Walid A Farhat
- Division of Pediatric Urology, Department of Urology, University of Wisconsin, Madison, USA.
| | - Michael Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Mitchell Shiff
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jin Kyu Kim
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Rusul Al Kutbi
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Martha Pokarowski
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Martin A Koyle
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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15
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Richter J, Rickard M, Kim JK, Erdman L, Lorenzo AJ, Chua M. Predicting the Future of Patients with Obstructive Uropathy—A Comprehensive Review. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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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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Cascini V, Lauriti G, Di Renzo D, Miscia ME, Lisi G. Ureteropelvic junction obstruction in infants: Open or minimally invasive surgery? A systematic review and meta-analysis. Front Pediatr 2022; 10:1052440. [PMID: 36507128 PMCID: PMC9727311 DOI: 10.3389/fped.2022.1052440] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The historical gold standard treatment for ureteropelvic junction obstruction (UPJO) was the open Anderson-Hynes dismembered pyeloplasty (OP). Minimally invasive surgery (MIS) procedures, including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), have been reported to achieve better outcomes (i.e., decreased morbidity, reduced postoperative pain, superior esthetic results, and shortened length of hospital stay, LOS), with a success rate similar to OP. The main limitation of the MIS approach is the age and weight of patients, limiting these procedures to children >1 year. This study aims to evaluate the feasibility and benefits of MIS pyeloplasty compared to OP to surgically treat UPJO in children <1 year of age. MATERIALS AND METHODS A systematic review was independently performed by two authors. Papers comparing both techniques (MIS pyeloplasty vs. OP) in infants were included in the meta-analysis. Data (mean ± DS or percentage) were analyzed using Rev.Man 5.4 A p < 0.05 was considered significant. RESULTS Nine studies (eight retrospective and one prospective) meet the inclusion criteria. A total of 3,145 pyeloplasties have been included, with 2,859 (90.9%) OP and 286 (9.1%) MIS. Age at operation was 4.9 ± 1.4 months in OP vs. 5.8 ± 2.2 months in MIS, p = ns. Weight at surgery was 6.4 ± 1.4 kg in OP vs. 6.9 ± 1.4 kg in MIS, p = ns. Operative time was 129.4 ± 24.1 min for OP vs. 144.0 ± 32.3 min for MIS, p < 0.001. LOS was 3.2 ± 1.9 days for OP vs. 2.2 ± 0.9 days for MIS, p < 0.01. Postoperative complications were present in 10.0 ± 12.9% of OP vs. 10.9 ± 11.6% in MIS, p = ns. Failure of surgery was 5.2 ± 3.5% for OP vs. 4.2 ± 3.3% for MIS, p = ns. CONCLUSION The development of miniaturized instruments and technical modifications has made MIS feasible and safe in infants and small children. MIS presented a longer operative time than OP. However, MIS seemed effective for treating UPJO in infants, showing shortened LOS compared to OP. No differences have been reported with regard to the incidence of postoperative complications and failure of pyeloplasty. Given the low quality of evidence of the meta-analysis according to the GRADE methodology, we would suggest limiting MIS procedures in infants to only those high-volume centers with experienced surgeons.
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Affiliation(s)
- Valentina Cascini
- Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Giuseppe Lauriti
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Dacia Di Renzo
- Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Maria Enrica Miscia
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Gabriele Lisi
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
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Li J, Yang Y, Li Z, Fan S, Wang X, Yang Z, Liu P, Song H, Zhang W. Redo laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction: Propensity score matched analyses of a high-volume center. Front Pediatr 2022; 10:997196. [PMID: 36160807 PMCID: PMC9497869 DOI: 10.3389/fped.2022.997196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Review the experience of redo laparoscopic pyeloplasty (RLP) in patients with recurrent ureteropelvic junction obstruction (UPJO) in comparison to primary laparoscopic pyeloplasty (PLP) and redo open pyeloplasty (ROP), and determine the feasibility and effectiveness of RLP for recurrent UPJO in children. METHODS We retrospectively reviewed the clinical data of patients treated with transperitoneal PLP, RLP, and ROP for UPJO from December 2015 to December 2022. The Propensity score matching (PSM) was used to balance confounding variables. RLP patients were 1:4 matched with PLP and 1:3 matched with ROP. The primary outcomes were failure and post-operative complications. Complications were classified according to the Clavien-Dindo grading system. RESULTS The study included ten patients who underwent RLP, 43 patients who underwent ROP, and 412 patients who underwent PLP. The follow-up time ranged from 6 to 36 months in the RLP group, 12 to 60 months in the PLP group, and 24 to 54 months in the ROP group. In the RLP group, no failure but three post-operative complications (Clavien grade II) were observed during the follow-up. Compared with the PLP group, the older age, higher weight, larger pre-operative anteroposterior diameter (APD) and APD/cortical thickness (P/C ratio), longer operation time, and post-operative length of stay (LOS) in the RLP group (P < 0.05). After PSM, longer operation time and post-operative LOS were observed in the RLP group (P < 0.05). Compared with the ROP group, the older age, higher weight, and longer post-operative LOS in the RLP group (P < 0.05). After PSM, longer post-operative LOS was observed in the ROP group (P < 0.05). The failure and complication rates were comparable between RLP and PLP or RLP and ROP (P > 0.05). CONCLUSIONS Our result demonstrated that RLP performed as well as PLP except for a longer operation time. Compared with ROP, RLP has the advantages of a clearer surgical view, sufficient exposure, clearer anatomical landmark position, and minor trauma with a comparable clinical outcome. On experienced hands, RLP for recurrent UPJO after is a safe and effective procedure and should be considered an excellent alternative to the more commonly recommended ROP in select patients.
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Affiliation(s)
- Jiayi Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yang Yang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zonghan Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Songqiao Fan
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xinyu Wang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhenzhen Yang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Pei Liu
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Chandrasekharam VVS, Babu R, Arlikar J, Satyanarayana R, Murali Krishna N. Functional outcomes of pediatric laparoscopic pyeloplasty: post-operative functional recovery is superior in infants compared to older children. Pediatr Surg Int 2021; 37:1135-1139. [PMID: 33942133 DOI: 10.1007/s00383-021-04914-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/25/2022]
Abstract
AIM Laparoscopic pyeloplasty (LP) is less popular and considered less successful in infants compared to older children. There are few reports analyzing the functional results of LP in relation to age of surgery. The aim of this paper is to compare the functional results of LP in infants (group 1) with children over 1 year of age (group 2). MATERIAL AND METHODS The data of all children undergoing LP between August 2016 and July 2019 were retrospectively analyzed for patient details and follow-up. Only children (n = 135) with at least 1-year follow-up and completed post-operative ultrasound and diuretic renogram were included. All children underwent pre-operative and post-operative ultrasound and diuretic renogram; pre-operative, operative and post-operative parameters were compared between both groups. Statistical analysis was done using software; Mann-Whitney U test, Student t test, and Fisher's exact test were applied. RESULTS There were 71 infants (group 1) and 64 children > 1 year (group 2). Pre-operatively, all kidneys had SFU grade 3 or 4 HDN and 131/135 kidneys had a renal pelvic APD > 20 mm; all kidneys had unequivocal obstruction on DR. At surgery, the preferred drainage method was intra-operative antegrade placement of a JJ stent in 68 (96%) group 1 and 63 (98%) group 2 children. The remaining 4 cases (3 group 1, 1 group 2) had a nephrostomy with trans-anastomotic external stent placement, because the JJ stent could not be negotiated into the bladder. The demographic data and comparison of pre- and post-operative parameters between both groups are summarized in Tables 1 and 2, respectively. Group 1 had significantly more children with antenatal diagnosis of HDN (87% vs 56%, p = 0.0005). The 36 children with antenatal diagnosis in group 2 were initially followed expectantly; the indication for pyeloplasty was deterioration of SRF on serial DR, urinary infection, and pain, in 13, 14, and 9 children, respectively. The operating time was significantly longer in group 2 (p = 0.0001). There was no difference in the success of LP or complication rate in both groups. Group 2 had significantly more children with extrinsic obstruction (1.4% vs 17%, p = 0.001). All children underwent post-operative US and DR; a significant reduction in hydronephrosis (APD) on follow-up was noted in both groups (p = 0.0001). The mean pre-operative SRF in both groups was comparable (p = 0.088). The mean SRF in both groups improved significantly after LP; however, the mean post-operative SRF was significantly higher in group 1 when compared to group 2 (p = 0.0001). Furthermore, group 1 had significantly more kidneys demonstrating > 10% increase in SRF after LP (53% vs 26%, p = 0.0003). CONCLUSIONS The safety profile and success of LP in infants was comparable to older children. Infant LP took shorter time to perform, while older children had increased incidence of extrinsic obstruction. Infant kidneys demonstrated better functional improvement than older children after LP. These findings should encourage more surgeons to utilize LP for pyeloplasty even in infants.
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Affiliation(s)
- V V S Chandrasekharam
- Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India.
| | - Ramesh Babu
- Pediatric Urology, SRIHER, Chennai, Tamil Nadu, India
| | - Jamir Arlikar
- Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
| | - R Satyanarayana
- Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
| | - N Murali Krishna
- Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
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Pérez-Bertólez S, Martín-Solé O, García-Aparicio L. Comparison between mini-laparoscopy, conventional laparoscopy and open approach for ureteropelvic junction obstruction treatment in children. Scand J Urol 2021; 55:307-312. [PMID: 34227907 DOI: 10.1080/21681805.2021.1948098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of the study was to compare 3 mm mini-laparoscopy (mini LP), standard 5 mm laparoscopy (LP) and open surgery for pediatric pyeloplasty in a single center. METHODS Patients who underwent pyeloplasty from 1997 to 2017 at Hospital Sant Joan de Déu were prospectively collected. Demographic data, clinical, surgical and radiological variables were assessed. A multivariate logistic regression analysis was performed in order to identify risks for surgical complications, urinary leak and need for redo-surgery. RESULTS 340 pyeloplasties were performed in this period: 197 open, 30 LP and 113 mini LP. Independent risk factors for surgical complications in a multivariate logistic regression model were: LP (vs mini LP, OR = 3.95; 95% CI: 1.13-13.8), higher differential renal function (each point more increases the risk 6%; 95% CI: 1-11%), older children (every year increases the risk 1.11 times; 95% CI: 1.002-1.225). Open surgery, pelvis diameter or the use of different stents were not risk factors. This model had an 80% PPV and a 92% NPV. LP (OR = 4.65; 95% CI: 1.08-19.96) and longer surgical time (OR = 1.014; 95% CI: 1.003-1.025) were independent risk factors for urinary leak. Higher pelvis diameter (OR = 0.93; 95% CI: 0.87-0.99) and the use of external stents were independent protective risk factors for urinary leak (OR = 0.09; 95% CI: 0.01-0.72). We have not found independent risk factors for redo-surgery in a multivariate logistic regression model. CONCLUSION mini LP can be safely and effectively used to perform pyeloplasty in pediatric patients of all ages.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Luis García-Aparicio
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Impact of Extracorporeal Stent Placement during Laparoscopic Pyeloplasty on Operative Duration. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:162-166. [PMID: 34349590 PMCID: PMC8298079 DOI: 10.14744/semb.2020.48243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/17/2020] [Indexed: 12/05/2022]
Abstract
Objectives: Ureteric stent insertion during laparoscopic pyeloplasty is the common practice for the reconstruction of ureteropelvic junction obstruction (UPJO). The long and hard learning curve of the method leads still controversy among surgeons. The utility of extracorporeal stent insertion in terms of shortening the length of operation time will be discussed in this study. Methods: A total of 36 children who underwent pyeloplasty for UPJO were evaluated retrospectively. Indications for pyeloplasty were: Obstruction findings in renal scintigraphy, progressive kidney function loss, increasing in anteroposterior pelvis diameter in renal ultrasonography, and current clinical symptoms (febrile urinary tract infection and flank pain). Extracorporeal stent insertion procedure was performed as the following order: Ureteropelvic area and ureter were visualized transperitoneal by three trochars, and UPJO was excised. Thereafter, the ureter is taken out of the skin from pelvic trochar entrance and is spatulated. JJ stent is placed into the ureter. Following this move, the ureter is taken into the intra-abdominal area and first ureteropelvic suture is performed intra-abdominally. Results: Thirteen of patients were girls and 23 were boys. Open surgery was applied for 15 patients (Group 1) and laparoscopic pyeloplasty (Group 2) to 21 patients. In Group 2, JJ stent was placed intracorporeally for six patients (Group 2a) and extracorporeally for the other 15 patients (Group 2b). The average age in Group 1 was 49.2±52 months; it was 86±29 months in Group 2a and 144±52 months in Group 2b, and the significant difference was present (p<0.001). There was statistically significant difference between Group 1 and Group 2 regarding with mean hospital stay (40 h in Group 1 and 42 h in Group 2; p=0.001). Post-operative JJ stent removal time was 58.8 days in Group 1 and 52.89 days in Group 2. In Group 2b patients, placing the stent extracorporeally took a significantly shorter operation time and the difference between the operation times of the groups (2a [192 min±3.76] and 2b [135 min±2.6] [p<0.001]) was statistically significant. No statistical difference was found between Group 1 (9.87±5.5 mm) and Group 2 (12.91±5.3 mm) in terms of renal anteroposterior diameters in the control ultrasonographic evaluation at the post-operative 2nd year (p=0.23). There was no difference between the two groups as a result of the evaluation of renal functions by scintigraphy at the post-operative 1st year (Group 1: 3.95±2%; and Group 2: 0.78±5.3%). Conclusion: According to the consequences in this study, extracorporeally ureteric stent insertion during laparoscopic pyeloplasty shortens the length of operation duration so that extracorporeal insertion might be preferred in cases where it is difficult to place the stent during laparoscopic pyeloplasty.
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Hiyoshi Y, Miyamoto Y, Akiyama T, Daitoku N, Sakamoto Y, Tokunaga R, Eto K, Nagai Y, Iwatsuki M, Iwagami S, Baba Y, Yoshida N, Baba H. Time trial of dry box laparoscopic surgical training improves laparoscopic surgical skills and surgical outcomes. Asian J Endosc Surg 2021; 14:373-378. [PMID: 33084215 DOI: 10.1111/ases.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The present study assessed the utility of a dry box time trial during laparoscopic surgical training to improve laparoscopic surgical skills and surgical outcomes. METHODS In a monthly time trial, surgeon trainees twice completed a set task that involved grasping a suture, aligning a needle with a needle holder, passing the suture, making three knots, and cutting the two tails of the suture. The mean suturing time was then analyzed. To assess the utility of this time trial, we analyzed the short-term outcomes of patients with stage I to III colon cancer who had undergone laparoscopic colectomy before and after the introduction of the time trial. RESULTS The monthly time trial was introduced in October 2018, and 52 surgeon trainees participated in the trials examined in this study. Within 6 months of the program's introduction, the mean suturing time had significantly declined to less than 70% of the time trial, while the standard deviations had declined to less than 30%. In comparisons of the short-term outcomes of laparoscopic colon cancer surgery before (n = 49) and after (n = 46) the introduction of the time trial, the operative time tended to decline (P = .074) after the introduction of the time trial, and blood loss was significantly reduced (P = .018). The rate of postoperative complications was similar before and after the introduction. CONCLUSION Regular time trials of laparoscopic surgical suture training using a dry box can be useful for improving laparoscopic surgical skills and surgical outcomes. Moreover, time trials can keep trainees motivated.
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Affiliation(s)
- Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nobuya Daitoku
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryuma Tokunaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yohei Nagai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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CUAJ E. Poster Exhibit 6: Pediatric Urology. Can Urol Assoc J 2021; 15:S140-S143. [PMID: 34162476 DOI: 10.5489/cuaj.7405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Song P, Shu M, Peng Z, Yang L, Zhou M, Wang Z, Lu N, Pei C, Dong Q. Transperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis. Asian J Surg 2021; 45:1-7. [PMID: 33867239 DOI: 10.1016/j.asjsur.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to evaluate the benefits and safety of transperitoneal and retroperitoneal pyeloplasty for ureteropelvic junction obstruction by a meta-analysis. We searched the databases including PubMed, Cochrane Library and Embase database from their inception to December 1st, 2020. Relevant literatures comparing retroperitoneal pyeloplasty with transperitoneal pyeloplasty were identified. A meta-analysis was conducted with Revman 5.3. The main outcomes included success rate, operative time, hospital stay, conversion rate of open surgery, overall complications, and detailed postoperative complications/indicators. 15 studies with 1881 patients were included. The results revealed that there were no significant differences between two approaches in success rate [OR = 1.51, 95%CI (0.94, 2.41), p = 0.09], hospital stay [MD = 0.21, 95%CI (-0.12, 0.54), p = 0.21] and overall complications [OR = 1.07, 95%CI (0.76, 1.50), p = 0.69]. The retroperitoneal approach was associated with longer operative time [MD = -26.91, 95%CI (-40.97, -12.84), p < 0.001], higher conversion rate [OR = 0.23, 95%CI (0.11, 0.47), p < 0.001] than the transperitoneal approach. As for the detailed postoperative complications/indicators, there were no significant differences between two approaches in the urinary leak, mild hematuria, fever, UPJO recurrence, infection and subcutaneous emphysema, as well as split renal function, renal pelvis anteroposterior diameter. The funnel plots showed that there were no obvious publication biases in our analysis. Therefore, we concluded that transperitoneal and retroperitoneal approaches had similar benefits and safety in success rate, hospital stay, overall complications and detailed postoperative complications/indicators. However, retroperitoneal was associated with longer operative time and higher conversion rate than transperitoneal approach. With the limitations of our study, additional high-quality studies are still essential for further evaluation.
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Affiliation(s)
- Pan Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mengxuan Shu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zhufeng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Luchen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mingzhen Zhou
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zirui Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ni Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Caixia Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Wong YS, Pang KKY, Tam YH. Comparing Robot-Assisted Laparoscopic Pyeloplasty vs. Laparoscopic Pyeloplasty in Infants Aged 12 Months or Less. Front Pediatr 2021; 9:647139. [PMID: 34195160 PMCID: PMC8236621 DOI: 10.3389/fped.2021.647139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
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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Affiliation(s)
- Yuenshan Sammi Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yuk Him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Kim SH, Kim WB, Kim JH, Lee SW. Robot-assisted laparoscopic pyeloureterostomy for ureteropelvic junction rupture sustained in a traffic accident: A case report. World J Clin Cases 2020; 8:5802-5808. [PMID: 33344577 PMCID: PMC7716323 DOI: 10.12998/wjcc.v8.i22.5802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ureteral reconstruction is a highly technical type of laparoscopic or open surgery. The incidence of ureteral injury is low; however, ureteral injuries tend to be overtreated. Robotic surgery for urinary reconstructive surgery is growing in popularity, which has made procedures such as pyeloplasty, ureteroureterostomy, and ureteroneocystostomy possible, with minimal damage to the patient. To the best of our knowledge, this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea, in a 17-year-old female patient with a ureteral injury.
CASE SUMMARY The patient, a 17-year-old girl without previous medical history, was presented at the emergency room and complained of abdominal and back pain. Tenderness in the right upper quadrant was observed on physical examination. Hemorrhage in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography (CT) scan. Ureteral injury was not suspected at this time. The patient was stabilized via conservative treatment, but complained of right flank pain 3 wk later and revisited the emergency room. An enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right kidney. Retrograde and antegrade pyelography were performed. Extravasation and discontinuity of the ureter were found. A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was performed. After 3 mo, the patient did not complain of any symptoms without any abnormal radiologic findings.
CONCLUSION This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.
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Affiliation(s)
- Si Hyun Kim
- Department of Urology, Soonchunhyang University Cheonan Hospital, Cheonan 31151, South Korea
| | - Woong Bin Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul 04401, South Korea
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
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Chua ME, Ming JM, Kim JK, Milford KL, Silangcruz JM, Ren L, Rickard M, Lorenzo AJ. Meta-analysis of retroperitoneal vs transperitoneal laparoscopic and robot-assisted pyeloplasty for the management of pelvi-ureteric junction obstruction. BJU Int 2020; 127:687-702. [PMID: 33030262 DOI: 10.1111/bju.15264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage pelvi-ureteric junction obstruction (PUJO) through a meta-analysis of comparative studies. METHODS A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane Collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals (CIs) were extrapolated. Subgroup analyses were performed according to study design and techniques. International Prospective Register of Systematic Reviews (PROSPERO) number: CRD42020163303. RESULTS A total of 18 studies describing 2007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR 0.99; 95% CI 0.97, 1.01), complications (RR 1.09; 95% CI 0.82, 1.45), OT (SMD 0.61; 95% CI -0.04, 1.26), LOS (SMD -0.30; 95% CI -0.63, 0.04), EBL (SMD -0.53; 95% CI -1.26, 0.21), or analgesic requirements (SMD -0.51; 95% CI -1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal LP had a higher conversion rate (RR 2.40; 95% CI 1.23, 4.66); however, patients resumed diets earlier (SMD -2.49; 95% CI -4.17, -0.82) and had shorter drain duration (SMD -0.31; 95% CI -0.57, -0.05). CONCLUSION The evidence suggests that there are no significant differences in success rate, OT and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher with the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.
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Affiliation(s)
- Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, QC, NCR, Quezon City, Philippines
| | - Jessica M Ming
- Section of Urology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Jin Kyu Kim
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen L Milford
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lily Ren
- Learning Commons, Learning Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Lane Medical Library, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
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Rehman OF, Umair M, Hussain AK, Faraz A, Iqbal M, Waqar M, Tahir M, Khan AR. Laparoscopic Versus Open Pyeloplasty for Primary Pelvic Ureteric Junction Obstruction: A Prospective Single Centre Study. Cureus 2020; 12:e11087. [PMID: 33235822 PMCID: PMC7679050 DOI: 10.7759/cureus.11087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The aim of the study was to compare the clinical and patient-reported outcomes among open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) patients. Materials and methods This was a prospective single centre, case-cohort study conducted in a tertiary care hospital with 62 patients. In both techniques, dismembered Anderson-Hynes pyeloplasty were undertaken. Post-operatively patients underwent visual analogue scale (VAS) assessment for pain, days to ambulation and comparison of the short- and long-term outcomes of the two procedures. Results There was no difference in the physical and functional outcomes between the two surgical approaches at 12 months period after surgery. However, patients in the laparoscopic group did report a higher rate of satisfaction at six weeks and six months’ postoperatively. Likewise, patients in LP experienced less pain during the postoperative period (p-value <0.001), with decreased analgesic requirements. This translated into an early patient ambulation in the laparoscopic group (p-value <0.001), and a shorter hospital stay for the LP group (p-value <0.001). Moreover, follow-up ultrasound showed equal improvement of hydronephrosis among the two groups. Conclusion Laparoscopic and open pyeloplasty are equally effective in treating pelvic ureteric junction obstruction (PUJO), with comparable patient-reported outcomes at 12-month follow-up. However, the laparoscopic technique merits over open surgery with faster rehabilitation, a decreased postoperative pain experience and shorter hospital stay.
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Affiliation(s)
- Omer Farooq Rehman
- Urology, Armed Forces Institute of Urology, Rawalpindi, PAK.,Urology, Maqsood Medical Complex and General Hospital, Peshawar, PAK
| | - Musab Umair
- Urology, Armed Forces Institute of Urology, Rawalpindi, PAK.,Urology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Ahmad Faraz
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | - Mohammad Iqbal
- Orthopaedics and Trauma, Royal Shrewsbury and Telford Hospital National Health Service Trust, Shrewsbury, GBR
| | - Muhammad Waqar
- Urology, Maqsood Medical Complex and General Hospital, Peshawar, PAK
| | - Muhammad Tahir
- Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Dong JJ, Wen S, Liu X, Lin T, Liu F, Wei GH. Trans-uretero-cystic external urethral stent for urinary diversion in pediatric laparoscopic pyeloplasty: A novel approach. Medicine (Baltimore) 2020; 99:e22135. [PMID: 33080671 PMCID: PMC7571912 DOI: 10.1097/md.0000000000022135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We present a new approach for urine drainage in pediatric patients following laparoscopic pyeloplasty, the trans-uretero-cystic external urethral stent (TEUS). METHODS We retrospectively identified 85 children who underwent laparoscopic pyeloplasty from July 2015 to June 2017. The included children were assigned to group A (double-J stent) or group B (TEUS). In group A, the double-J stent was removed by a cystoscopy under anesthesia after 1 month, while in group B, the external stent was removed after 5 to 7 days. We examined the durations of operation, hospital stay and the frequency of stent-related complications including urinary leakage, stent dislocation, stent occlusion, and urinary tract infection. RESULTS The operation time was significantly longer for patients in group B than for those in group A. No significant difference was observed between the groups regarding stent-related complications. In group A, 4 patients need auxiliary stent re-insertion for the management of complications, 2 developed urinary tract infection, and 2 had stent occlusion. In group B, none needed auxiliary stent re-insertion for complications and avoided re-operation. CONCLUSIONS In children, the outcome of external stent implantation was similar to that using double-J stent, and the use of the former approach may be beneficial for younger children.
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Affiliation(s)
- Jun-Jun Dong
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's hospital of Chongqing Medical University, Chongqing, PR China
| | - Sheng Wen
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's hospital of Chongqing Medical University, Chongqing, PR China
| | - Xing Liu
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's hospital of Chongqing Medical University, Chongqing, PR China
| | - Tao Lin
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's hospital of Chongqing Medical University, Chongqing, PR China
| | - Feng Liu
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's hospital of Chongqing Medical University, Chongqing, PR China
| | - Guang-Hui Wei
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's hospital of Chongqing Medical University, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering; Chongqing Key Laboratory of Pediatrics
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Schukfeh N, Kuebler JF, Dingemann J, Ure BM. Thirty Years of Minimally Invasive Surgery in Children: Analysis of Meta-Analyses. Eur J Pediatr Surg 2020; 30:420-428. [PMID: 31013537 DOI: 10.1055/s-0039-1687901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In the last three decades, minimally invasive surgery (MIS) has been widely used in pediatric surgery. Meta-analyses (MAs) showed that studies comparing minimally invasive with the corresponding open operations are available only for selected procedures. We evaluated all available MAs comparing MIS with the corresponding open procedure in pediatric surgery. MATERIALS AND METHODS A literature search was performed on all MAs listed on PubMed. All analyses published in English, comparing pediatric minimally invasive with the corresponding open procedures, were included. End points were advantages and disadvantages of MIS. Results of 43 manuscripts were included. MAs evaluating the minimally invasive with the corresponding open procedures were available for 11 visceral, 4 urologic, and 3 thoracoscopic types of procedures. Studies included 34 randomized controlled trials. In 77% of MAs, at least one advantage of MIS was identified. The most common advantages of MIS were a shorter hospital stay in 20, a shorter time to feeding in 11, and a lower complication rate in 7 MAs. In 53% of MAs, at least one disadvantage of MIS was found. The most common disadvantages were longer operation duration in 16, a higher recurrence rate of diaphragmatic hernia in 4, and gastroesophageal reflux in 2 MAs. A lower native liver survival rate after laparoscopic Kasai-portoenterostomy was reported in one MA. CONCLUSION In the available MAs, the advantages of MIS seem to outnumber the disadvantages. However, for some types of procedures, MIS may have considerable disadvantages. More randomized controlled trials are required to confirm the advantage of MIS for most procedures.
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Affiliation(s)
- Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Abstract
Robotic surgery has been slow to be fully accepted in the world of pediatric urology largely because of its initial application directed towards adult use and because of the inherent high cost associated with it. However, as previously shown, it has now become the gold standard for adolescent pyeloplasty in The United States. As the adoption of robotic surgery in children has become more widespread, its use has been applied to a broader spectrum of procedures with similar success rates to standard laparoscopy. These procedures include nephrectomy, heminephrectomy, ureteral reimplantation, and ureteroureterostomy. However, it has also shown feasibility and comparable success when compared to open surgery in procedures that were previously deemed too complex to be done by standard laparoscopy. For example, bladder neck reconstruction with Mitrofanoff and Malone procedure as well as bladder augmentation. This review objective is to provide an overview of robotic surgery in pediatric urology, with a focus on the more common cases such as pyeloplasty and reimplantation as well as more complex bladder reconstruction procedures.
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He Y, Song H, Liu P, Sun N, Tian J, Li M, Li N, Qu Y, Han W, Feng G, Ni X, Zhang W. Primary laparoscopic pyeloplasty in children: A single-center experience of 279 patients and analysis of possible factors affecting complications. J Pediatr Urol 2020; 16:331.e1-331.e11. [PMID: 32334969 DOI: 10.1016/j.jpurol.2020.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty (LP) has been widely used in the treatment of pediatric ureteropelvic junction obstruction (UPJO). However, no prior reports with a large pediatric series have focused on the analysis of complications and impact factors of the outcomes. We hypothesized there were risk factors of higher Clavien grade postoperative complications. OBJECTIVE To analyze the characteristics of complications and risk factors of high Clavien grade postoperative complications. PATIENTS AND METHODS All children with UPJO treated with primary transperitoneal LP between July 2016 and July 2018 were retrospectively reviewed. The Clavien complication grades in groups with different weight, intraoperative complication (drainage methods), anteroposterior pelvic diameters (APPD), side, gender, title of surgeon, preoperative presentation and obstruction reason were compared. RESULTS Of the 279 children, intraoperative complications in which the placement of double-J stents was not accomplished and conversion to open surgery (Satava grade II) occurred in 17 (6.09%) and 2 (0.72%) patients, respectively. A total of 270 patients (277 kidneys) were included in the analysis of postoperative complications. Postoperative complications occurred in 51 (18.89%) patients. The most frequent postoperative incident was febrile UTI in 27 patients. Of the 13 patients who required reoperations, 6 patients had kidney restenosis and were considered as failure of surgery. All complications with an exact onset time occurred within 10 months after surgery. In the univariate and multivariate analysis, weight <10 kg and having intraoperative complication with nephrostomy tube were risk factors of higher Clavien postoperative complication grade (P<0.05). DISCUSSION Patients who were <10 kg in weight and having intraoperative complication with nephrostomy tube had a greater risk of a higher Clavien grade postoperative complication. To reduce high Clavien grade postoperative complications, asymptomatic patients under 10 kg in weight and having intraoperative complication with nephrostomy tube need close monitoring. In the 26 patients who had an exact time of the postoperative complications, the longest time we found was 10 months. Thus, we recommend the follow-up time required to observe postoperative complications in patients should be at least 10 months after surgery. CONCLUSIONS LP has been proven to be safe and effective in children with a low rate of complications. Weight <10 kg and having intraoperative complications with nephrostomy tube were risk factors of higher Clavien grade postoperative complications. Children with low weight and intraoperative complications need more attention in terms of the occurrence of complications.
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Affiliation(s)
- Yuzhu He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jun Tian
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Minglei Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yanchao Qu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenwen Han
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Guoshuang Feng
- Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xin Ni
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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iTRAQ-based proteomics and in vitro experiments reveals essential roles of ACE and AP-N in the renin-angiotensin system-mediated congenital ureteropelvic junction obstruction. Exp Cell Res 2020; 393:112086. [PMID: 32416091 DOI: 10.1016/j.yexcr.2020.112086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ureteropelvic junction obstruction (UPJO) is a common renal obstructive disorder, but its pathogenic mechanisms remain largely unclear. We aimed to investigate the potential involvement of the renin-angiotensin system in congenital UPJO pathogenesis. METHODS Differentially expressed proteins in exosomes isolated from amniotic fluid of patients with congenital UPJO were characterized using iTRAQ (isobaric tags for relative and absolute quantification)-based proteomics. The expressions of angiotensin-converting enzyme (ACE) and aminopeptidase N (AP-N) in HK2 cells were inhibited by quinapril and siRNA, respectively. Cell proliferation and reactive oxygen species were measured by EdU staining and flow cytometry, respectively. Gene expression was detected by Western blot or qRT-PCR. The inflammatory factors were measured through ELISA. Mice that underwent unilateral ureteral obstruction were used as the animal model. RESULTS The identity of exosomes from amniotic fluids was confirmed by the expression of CD9 and CD26. In total, 633 differentially expressed proteins were identified in the amniotic fluid-derived exosomes from patients with UPJO, including 376 up- and 257 down-regulated proteins associated with multiple biological processes. Of them, ACE and AP-N were significantly decreased in the amniotic fluid exosomes. Inhibition of ACE and AP-N resulted in suppressed cell proliferation; repressed IARP, AT1R, and MAS1 expression; elevated ROS production; and increased IL-1β, TNF-α, and IL-6 levels in HK2 cells. Decreased ACE expression and elevated IL-1β levels were also observed in the mouse model. CONCLUSION Suppression of ACE and AP-N expression mediates congenital UPJO pathogenesis by repressing renal tubular epithelial proliferation, promoting ROS production, and enhancing inflammatory factor expression.
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Uhlig A, Uhlig J, Trojan L, Hinterthaner M, von Hammerstein-Equord A, Strauss A. Surgical approaches for treatment of ureteropelvic junction obstruction - a systematic review and network meta-analysis. BMC Urol 2019; 19:112. [PMID: 31711468 PMCID: PMC6849262 DOI: 10.1186/s12894-019-0544-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 10/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.
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Affiliation(s)
- Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.,Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Arne Strauss
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
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Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy? World J Urol 2019; 38:1827-1833. [PMID: 31506749 DOI: 10.1007/s00345-019-02943-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Open pyeloplasty (OP) has been the first-line treatment for ureteropelvic junction obstruction (UPJO) since it was first described by Anderson and Hynes. The use of minimally invasive surgery (MIS) to treat UPJO in the pediatric population has increased in recent years, due to decreased morbidity and shorter recovery times. Recently, robot-assisted laparoscopic pyeloplasty (RALP) has seen a steady expansion. Unlike laparoscopic pyeloplasty (LP), RALP comes with a more manageable learning curve aided by specialized technological advantages such as high-resolution three-dimensional view, tremor filtration with motion scaling, and highly dexterous wrist-like instruments. With this review, we aim to highlight the trend toward robotic pyeloplasty over laparoscopy and current available evidence on outcomes. METHODS We systematically searched the PubMed and EMBASE databases, and we critically reviewed the available literature on the use of laparoscopy and robotic technology in pediatric patients with UPJO. RESULTS Overall, we selected 19 original articles and 5 meta-analyses. The available literature showed that the robotic approach to the UPJO allowed for decreased operative times, shorter length of hospital stay, lower complication rates, with success rates comparable to LP. Conflicting results persist regarding robotic platform and equipment costs. CONCLUSION While laparoscopy requires advanced skills for complex reconstructive procedures, such as pyeloplasty, robot-assisted surgery offers the valuable potential of making MIS more accessible to these types of procedure. Robotic technology has contributed to shortening the learning curve by acting as a bridge between open and endoscopic approach. There is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials, as well as further cost-effectiveness analyses. As robotic surgical technology spreads, future systems will be developed, offering smaller and more flexible tools, allowing enhanced applications on pediatric patients.
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Liu X, Huang C, Guo Y, Yue Y, Hong J. Comparison of DJ stented, external stented and stent-less procedures for pediatric pyeloplasty: A network meta-analysis. Int J Surg 2019; 68:126-133. [DOI: 10.1016/j.ijsu.2019.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 01/08/2023]
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Comparison of 30-day postoperative outcomes of open and minimally invasive pyeloplasty utilizing the prospective National Surgical Quality Improvement Program-Pediatric database. J Pediatr Urol 2019; 15:355.e1-355.e8. [PMID: 31229417 DOI: 10.1016/j.jpurol.2019.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/18/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Open pyeloplasty (OP) has traditionally been the standard for the operative management of ureteropelvic junction obstruction in children. With advances in minimally invasive pyeloplasty (MIP) techniques, it is quickly becoming a popular alternative in both adult and pediatric population. OBJECTIVE To evaluate the differences in outcomes between MIP and OP for the surgical correction of ureteropelvic junction obstruction in children. STUDY DESIGN Data were obtained from the pediatric National Surgical Quality Improvement Program 2012-2017. We identified 1280 patients who underwent MIP and 1190 patients who underwent OP between 2012 and 2017. Propensity score matching was utilized to adjust for baseline differences. Univariate and multivariable regression were performed to assess odds of complications and procedure-related readmission. RESULTS Patients who underwent OP had a significantly decreased operative time (192.42 vs 142.00 min, p < 0.001) compared to MIP. There was no significant difference in the rates of overall peri-operative complications (3.7% [MIP] vs 2.4% [OP] p = 0.397). On multivariable analysis, patients undergoing OP had a lower risk of procedure-related readmission (odds ratio [OR] 0.404, 95% confidence interval [CI] 0.157-0.951, p = 0.046) than MIP. In a multivariable linear regression model, the risk of having any postoperative complication, regardless of surgical approach, decreased with increasing patient age (OR 0.945, 95% CI 0.893-0.996, p = 0.037). DISCUSSION Although recent small, retrospective institutional studies have found decreased hospitalization time of MIP as compared to OP, in our large prospective database, we found no such association. While some studies suggest a higher rate of wound complications in the OP group, this was not reproduced in our study as well. MIP was, in fact, associated with higher rate of readmissions as compared to the OP group, which may act as a surrogate of long-term complications in these patients. CONCLUSION MIP offers an alternative to OP in the pediatric population with similar rates of peri-operative complications. However, our study shows decreased odds of procedure-related readmission in OP, which may serve as a surrogate for less postoperative complications in these patients.
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Gaboardi F, Mantica G, Smelzo S, Pini G, Marchi DD, Passaretti G, Saitta G, Rigatti L, Suardi N. Robotic-assisted laparoscopic pyeloplasty with the use of the Contour™ stent: description of the technique and analysis of outcomes after the first 30 cases. Cent European J Urol 2019; 72:51-53. [PMID: 31011440 PMCID: PMC6469006 DOI: 10.5173/ceju.2018.1844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 12/29/2018] [Accepted: 12/29/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction We present a technical variation of robot-assisted pyeloplasty (RAP) using the Contour™ stent that allows a minimal incision of the retroperitoneum. Material and methods The main difference from the standard robot-assisted pyeloplasty (RAP) is the preventive retrograde insertion of a Contour™ stent, which is a single J stent subsequently easily convertible in a double J stent. Results The mean operative time was 141.2 minutes. Blood losses were negligible, median length of stay was 4 days. Conclusions The use of a Contour™ stent showed to be a safe and feasible technical variation while performing a RAP.
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Affiliation(s)
- Franco Gaboardi
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Guglielmo Mantica
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Salvatore Smelzo
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Giovannalberto Pini
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Davide De Marchi
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Giovanni Passaretti
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Giuseppe Saitta
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Lorenzo Rigatti
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
| | - Nazareno Suardi
- Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy
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Wong MCY, Sertorio F, Damasio MB, Incarbone V, Beati F, Bodria M, Pistorio A, Ghiggeri GM, Magnano GM, Mattioli G. Surgical validation of functional magnetic resonance urography in the study of ureteropelvic junction obstruction in a pediatric cohort. J Pediatr Urol 2019; 15:168-175. [PMID: 30553558 DOI: 10.1016/j.jpurol.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is one of the most common urological diseases in children. The etiology can be intrinsic, extrinsic (crossing vessel [CV] or adhesions), or mixed. To date, ultrasonography and scintigraphy are considered gold-standard imaging techniques for the study of UPJO. Functional magnetic resonance urography (fMRU) combines anatomical and functional information and has been recently evaluated for the detection of CVs in UPJO. OBJECTIVE The objective of the study was to evaluate the concordance between fMRU and surgery in determining the etiology of UPJO and the presence of obstructing/non-obstructing CVs. STUDY DESIGN Patients with unilateral hydronephrosis who underwent surgery after an fMRU were included in the sample. Surgical data regarding the etiology of UPJO were compared with radiological results. The etiology was divided into intrinsic, extrinsic due to CV, extrinsic due to adhesions, and mixed or cicatricial (postoperative). The concordance was calculated by means of the Cohen's kappa coefficient. RESULTS The observed agreement between fMRU and surgical findings regarding the etiology and the presence of CV were 83.2% and 89.4%, respectively (with substantial Cohen's kappa coefficient). The sensitivity and specificity of fMRU were 0.84 and 0.93, respectively; the positive predictive value (PPV) and negative predictive value (NPV) were 0.889 and 0.897, respectively. The observed agreement regarding the type of vessel was 88.3% with a Cohen's kappa coefficient of 0.787 (substantial). DISCUSSION In children with hydronephrosis, it is very important for the surgeon to quantify the extent of dilation, define the etiology of the obstruction, and the presence or absence of CVs. fMRU is a 'one-stop-shop' technique which provides both anatomical and functional information showing a high concordance with surgical findings, avoiding radiation exposure. CONCLUSIONS fMRU should be considered a valid imaging technique in the study of pediatric UPJO, as it provides the surgeon with important information regarding the etiology of the obstruction for the preoperative planning.
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Affiliation(s)
- M C Y Wong
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - F Sertorio
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; University of Genoa, Via Balbi 5, 16126, Genoa, Italy.
| | - M B Damasio
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - V Incarbone
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - F Beati
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - M Bodria
- Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - A Pistorio
- Epidemiology and Biostatistics Service, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G M Ghiggeri
- Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G M Magnano
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G Mattioli
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
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Abstract
Pyeloplasty is one of the most common urological reconstructive interventions. Since the presentation of the first open pyeloplasty by Anderson and Hynes in 1949, the management of ureteropelvic junction obstruction has dramatically developed. The most immense progress was made in the 1990s with the introduction of laparoscopy. A multitude of new minimal surgical techniques have been introduced since then. In the last few years, the innovations were based on refinement of already-existing techniques and technology. With this aim, single-port surgery, three-dimensional vision for laparoscopy, robotic technology, and alternative techniques for creating the anastomosis-like fibrin glue have been introduced. This unsystematic review is timely, and the scientific interest is to present and discuss some of the latest advances in surgical techniques and different approaches for the intra- and post-operative management in pyeloplasty. To the best of our knowledge, this is the only review looking at the recent advances in urological surgical techniques for pyeloplasty during the last few years with a focus on new technology and surgical techniques.
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Affiliation(s)
- Mikolaj Mendrek
- Departement of Urology, University Hospital Aachen, Aachen, 52074, Germany
| | | | - Christian Bach
- Departement of Urology, University Hospital Aachen, Aachen, 52074, Germany
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Zamfir Snykers C, De Plaen E, Vermersch S, Lopez M, Khelif K, Luyckx S, Philippe P, Varlet F, Steyaert H. Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option? Front Pediatr 2019; 7:352. [PMID: 31608264 PMCID: PMC6773808 DOI: 10.3389/fped.2019.00352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Laparoscopic pyeloplasty in children younger than 1 year of age is still debatable due to its supposed technical difficulties and failure rate. We present our experience and outcome in infants. Materials and Methods: A retrospective study was conducted in 3 Departments of Pediatric Surgery. We reviewed the records of the children under 1 year of age operated on for ureteropelvic junction obstruction (UPJO), between 2007 and 2017. Anderson-Hynes laparoscopic transabdominal dismembered pyeloplasty was performed. Patients' demographics, results of preoperative and postoperative exams, perioperative details, complications, hospital stay, and long-term follow-up results were analyzed. Results: Sixty cases were operated on during this period (49 boys, 11 girls). Mean age at operation was 4.5 months (1-12 months). Mean operating time was 140 min (80-240 min). There was no conversion in this group. There were four early complications: 1 ileus, 1 hypertension immediately post-operatively requiring medical treatment, 1 omental herniation through a drain orifice, and 1 percutaneous transanastomotic stent migrated intra-abdominally. The two last children had to be reoperated. Mean hospital stay was of 2 days (1-10 days). Late complications: two patients (3.4%) presented a recurrence of UPJO, one had been re-operated 15 months later and for the patient with persistent hypertension, nephropexy was performed for malrotated kidney, 1 year after pyeloplasty. Long term follow-up with a mean of 2.8 years (1-10 years) showed that surgery improved mean pelvic dilatation from 31.8 mm (13-63 mm) preoperatively to 15.3 mm (4-40 mm) postoperatively (P < 0.0001). The renal function slightly improved, from a mean of 35.7% (5-55%) it passed to 40.5% (0-54%), p = 0.137. In three cases the operated kidney became finally non-functional and atrophic. Conclusions: Laparoscopic transperitoneal pyeloplasty is feasible and safe in children younger than 1 year of age. Nevertheless, it requires experience and good intra-abdominal suturing skills. Laparoscopic pyeloplasty has a success rate comparable with open treatment but with less morbidity and better cosmetic results.
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Affiliation(s)
- Corina Zamfir Snykers
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elea De Plaen
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophie Vermersch
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Manuel Lopez
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Karim Khelif
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Stephane Luyckx
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Paul Philippe
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Francois Varlet
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Henri Steyaert
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Chan EKW, Lee KH, Wong VHY, Tsui BSY, Wong SYS, Pang KKY, Mou JWC, Tam PYH. Laparoscopic management of choledochal cysts in infants and children: A review of current practice. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Edwin Kin-Wai Chan
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Kim-Hung Lee
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Vicky Hei-Yi Wong
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Bess Siu-Yan Tsui
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Sammi Yuen-Shan Wong
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Kristine Kit-Yi Pang
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Jennifer Wai-Cheung Mou
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Peter Yuk-Him Tam
- Department of Surgery; The Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
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Aronson LR, Cleroux A, Wormser C. Use of a modified Boari flap for the treatment of a proximal ureteral obstruction in a cat. Vet Surg 2018; 47:578-585. [DOI: 10.1111/vsu.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/24/2017] [Accepted: 09/11/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Lillian R. Aronson
- Department of Clinical Sciences; Matthew J. Ryan Veterinary Hospital, University of Pennsylvania; Philadelphia Pennsylvania
| | - Andreanne Cleroux
- Department of Clinical Sciences; Matthew J. Ryan Veterinary Hospital, University of Pennsylvania; Philadelphia Pennsylvania
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Prospective evaluation of retroperitoneal laparoscopic pyeloplasty in children in the first 2 years of life: Is age a risk factor for conversion? J Pediatr Urol 2017; 13:511.e1-511.e4. [PMID: 28483468 DOI: 10.1016/j.jpurol.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty in children has stood the test of time. A clear advantage of laparoscopic pyeloplasty over open pyeloplasty has been proven both by retrospective and prospective trials. The aim of the current study was to address, in a prospective design, the outcomes, safety, conversion rates and risk factors for conversion in children aged <2 years who underwent retroperitonoscopic pyeloplasty by a single surgeon. PATIENTS AND METHODS In the period April 2014 to May 2016, 15 children with a median age of 6 months (range 1-24) and ureteropelvic junction (UPJ) obstruction were operated by a single surgeon using retroperitonoscopic pyeloplasty with antegrade renal stenting. The position and sites of tracers are shown in the figure. RESULTS With a median follow-up of 6 months, there were no recurrent cases of UPJO; one child had postoperative complications and recovered conservatively; median hospital stay was 1 day (range 1-7); and conversion to open pyeloplasty was encountered in three children (20%) aged <3 months. A statistically significant difference between laparoscopic and converted cases was present concerning the age (P = 0.048); neither gender nor side was significantly different. DISCUSSION Laparoscopic pyeloplasty in young children has been reported in many retrospective trials. Retroperitonoscopic pyeloplasty in young children has not been reported in prospectively designed studies to address safety and outcome. The current study reported experience in young children, defining the age category <3 months as a high-risk group for conversion to open surgery, but not to higher incidence of complications. CONCLUSION Retroperitonoscopic pyeloplasty in children aged <2 years is feasible, safe and successful. High conversion rates to open pyeloplasty have to be expected in children aged <3 months.
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Song SH, Lee C, Jung J, Kim SJ, Park S, Park H, Kim KS. A comparative study of pediatric open pyeloplasty, laparoscopy-assisted extracorporeal pyeloplasty, and robot-assisted laparoscopic pyeloplasty. PLoS One 2017; 12:e0175026. [PMID: 28426695 PMCID: PMC5398516 DOI: 10.1371/journal.pone.0175026] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 03/04/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare the outcomes of open pyeloplasty (OP), laparoscopy-assisted extracorporeal (LEXP), and robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction in pediatric patients. METHODS We retrospectively reviewed the age-matched cohort of 30 children who underwent OP, 30 who underwent LEXP, and 10 who underwent RALP at a single institution, from 1996 to 2014. Pre- and post-operative variables including success rate were compared among surgical groups. RESULTS The mean age of the patients was 120.2 months, the Society for Fetal Urology grade was 3.6, the anteroposterior diameter was 3.1 cm, and the renal relative function was 44.0%. The distribution of laterality, mean body mass index, and preoperative anteroposterior pelvic diameter on ultrasound did not differ among groups. The mean length of hospital stay was significantly shorter in the RALP group (3.2 days) than in the OP (6.6 days) and LEXP (5.8 days) groups (p<0.001). The duration of analgesics use was shorter in the RALP group (1.1 days) than in the other groups (p<0.001). During the mean follow-up period of 49.0, 20.1, and 16.6 months, the success rate was 96.7%, 89.7%, and 100% in the OP, LEXP, and RALP groups, respectively, although this difference was not statistically different (p = 0.499). In multivariate regression analysis, the presence of crossing vessels was the only factor that decreased the success rate (hazard ratio: 46.09, 95% confidence interval: 2.41-879.6, p = 0.011). CONCLUSIONS Patients who undergo RALP have a reduced hospital stay and lower use of pain medication; however, there is no difference in the success rates for OP, LP, and RALP surgeries. The presence of crossing vessels is a negative prognostic indicator for surgical outcome regardless of the surgical method.
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Affiliation(s)
- Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chanwoo Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaeyoon Jung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Jin Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyungkeun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- * E-mail:
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Cullis PS, Gudlaugsdottir K, Andrews J. A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery. PLoS One 2017; 12:e0175213. [PMID: 28384296 PMCID: PMC5383307 DOI: 10.1371/journal.pone.0175213] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify characteristics predictive of review quality. BACKGROUND Systematic reviews summarise evidence by combining sources, but are potentially prone to bias. To counter this, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was published to aid in reporting. Similarly, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) measurement tool was designed to appraise methodology. The paediatric surgical literature has seen an increasing number of reviews over the past decade, but quality has not been evaluated. METHODS Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify systematic reviews and meta-analyses of interventions in paediatric surgery. From 01/2010 to 06/2016, we searched: MEDLINE, EMBASE, Cochrane, Centre for Reviews and Dissemination, Web of Science, Google Scholar, reference lists and journals. Two reviewers independently selected studies and extracted data. We assessed conduct and reporting using AMSTAR and PRISMA. Scores were calculated as the sum of reported items. We also extracted author, journal and article characteristics, and used them in exploratory analysis to determine which variables predict quality. RESULTS 112 articles fulfilled eligibility criteria (53 systematic reviews; 59 meta-analyses). Overall, 68% AMSTAR and 56.8% PRISMA items were reported adequately. Poorest scores were identified with regards a priori design, inclusion of structured summaries, including the grey literature, citing excluded articles and evaluating bias. 13 reviews were pre-registered and 6 in PRISMA-endorsing journals. The following predicted quality in univariate analysis:, word count, Cochrane review, journal h-index, impact factor, journal endorses PRISMA, PRISMA adherence suggested in author guidance, article mentions PRISMA, review includes comparison of interventions and review registration. The latter three variables were significant in multivariate regression. CONCLUSIONS There are gaps in the conduct and reporting of systematic reviews in paediatric surgery. More endorsement by journals of the PRISMA guideline may improve review quality, and the dissemination of reliable evidence to paediatric clinicians.
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Affiliation(s)
- Paul Stephen Cullis
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Katrin Gudlaugsdottir
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - James Andrews
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
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Hong YH, DeFoor WR, Reddy PP, Schulte M, Minevich EA, VanderBrink BA, Noh PH. Hidden incision endoscopic surgery (HIdES) trocar placement for pediatric robotic pyeloplasty: comparison to traditional port placement. J Robot Surg 2017; 12:43-47. [DOI: 10.1007/s11701-017-0684-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/12/2017] [Indexed: 12/19/2022]
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Mei H, Zhao X, Li D, Fang E, Wang X, Song H, Pu J, Zheng L, Tong Q. Comparison of transumbilical multiport and standard laparoscopic pyeloplasty in children: Mid-term results at a single center. J Pediatr Surg 2017; 52:473-477. [PMID: 27614810 DOI: 10.1016/j.jpedsurg.2016.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/12/2016] [Accepted: 08/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the efficacy of transumbilical multiport (TMLP) and standard laparoscopic pyeloplasty (SLP) for the treatment of congenital ureteropelvic junction obstruction in children. METHODS Forty-eight patients were included in this matched-pair study. The TMLP applied three transumbilical incisions for one 5-mm and two 3-mm ports, whereas SLP was undertaken with traditional three-port technique. The demographic, perioperative, and follow-up data were retrospectively compared between TMLP (n=24) and SLP (n=24) groups. RESULTS Two groups were matched according to patient's age, gender, laterality, weight, and surgical indication. TMLP and SLP were successfully performed in all patients, without conversion to open procedure. There was no significant difference between both groups in intraoperative blood loss, time to oral feeding, time to normal activities, pain scores, or complication rates. Longer mean operative time (125.4±21.6 vs. 112.2±25.2 min; P=0.012) and better patient satisfaction (30.4±4.5 vs. 24.6±3.4; P=0.026) were noted in TMLP group than those in SLP group. Mid-term follow-up indicated no significant difference in postoperative alleviation of hydronephrosis or improvement of renal function. CONCLUSION TMLP is a feasible and efficient procedure for the management of congenital ureteropelvic junction obstruction in children, with comparative outcome and better cosmetic results than SLP.
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Affiliation(s)
- Hong Mei
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Xiang Zhao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Dan Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Erhu Fang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Xiaojing Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Huajie Song
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Jiarui Pu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Liduan Zheng
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China; Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China; Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, PR China.
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Bansal UK, Dangle PP, Stephany H, Durrani A, Cannon G, Schneck FX, Ost MC. Optimal Length of Follow-up for the Detection of Unsuccessful Pediatric Pyeloplasty: A Single-Center Experience. Front Pediatr 2017; 5:126. [PMID: 28620596 PMCID: PMC5451493 DOI: 10.3389/fped.2017.00126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/12/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the optimal length of follow-up for patients undergoing both open and minimally invasive pyeloplasties to ensure prompt detection of a recurrent obstruction. There are no standard guidelines on ideal follow-up and imaging post-pediatric pyeloplasty currently. METHODS A retrospective chart review identified 264 patients (<18 years old) who underwent pyeloplasty for ureteropelvic junction obstruction between April 2002 and December 2014. Ultrasound was obtained every 3-4 months for the first year following pyeloplasty and thereafter at discretion of treating physician. Patient characteristics including symptoms and imaging were reviewed. RESULTS Of the 264 patients, 72% were male with mean age of 51 months and follow-up of 26.8 months. Approximately 73% followed up to 3 years. Fourteen patients (5.3%) had a recurrent obstruction. Among the failures, 85% were diagnosed and underwent successful redo pyeloplasty within 3 years. Six infants had a recurrence (43% of all unsuccessful surgeries) and were diagnosed within 3 years of the initial surgery. Patients undergoing a minimally invasive procedure were less likely to be followed for more than 3 years compared to an open procedure (p < 0.001). Patients with severe hydronephrosis preoperatively were followed longer (p = 0.031). Age at surgery and type of surgical approach (p < 0.01) were significant predictors of length of follow-up in a negative binomial regression. CONCLUSION Based on the results, a minimum of 3 years of follow-up is necessary to detect the majority of recurrent obstructions. Those patients who have higher than average lengths of follow-up tend to be younger and/or underwent an open surgical approach.
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Affiliation(s)
- Utsav K Bansal
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Pankaj P Dangle
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Heidi Stephany
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Asad Durrani
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Glenn Cannon
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Francis X Schneck
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michael C Ost
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Torricelli FCM, Barbosa JABA, Marchini GS. Impact of laparoscopic surgery training laboratory on surgeon's performance. World J Gastrointest Surg 2016; 8:735-743. [PMID: 27933135 PMCID: PMC5124702 DOI: 10.4240/wjgs.v8.i11.735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/02/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.
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