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Esposito C, Masieri L, Castagnetti M, Sforza S, Farina A, Cerulo M, Cini C, Del Conte F, Escolino M. Robot-assisted vs laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO): technical considerations and results. J Pediatr Urol 2019; 15:667.e1-667.e8. [PMID: 31734119 DOI: 10.1016/j.jpurol.2019.09.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although both laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) have reported excellent clinical outcomes, no evidence is currently available about the best surgical approach for surgical treatment of children with uretero-pelvic junction obstruction (UPJO). OBJECTIVE This study aimed to compare the outcomes of LP and RALP in children with UPJO. STUDY DESIGN The medical records of all patients with UPJO, who underwent LP or RALP in three pediatric urology units over a 2-year period, were retrospectively reviewed. The authors excluded open pyeloplasty and cases with complex anatomy such as horseshoe kidney. A dismembered Anderson-Hynes pyeloplasty was performed in all cases. RESULTS Sixty-seven patients (39 boys and 28 girls) with a median age of 4 years (range 8 months-14 years) were included. Thirty-seven patients (55.2%) underwent RALP, and 30 patients (44.8%) underwent LP. Three patients of RALP group presented a recurrent UPJO. No significant difference was found in the median total operative time between RALP (133 min) and LP (139 min) (P = 0.33). The median anastomotic time was significantly shorter in RALP (79 min) compared with LP (105.5 min) (P = 0.001). Overall surgical success rate was 96.7% for LP and 100% for RALP (P = 0.78). As for postoperative complications, the authors recorded re-stenosis of UPJO in one LP patient (3.3%), who underwent redo-RALP. DISCUSSION According to the authors experience, robotic surgery should be indicated in patients older than 18-24 months with a body weight > 10-15 Kgs. Laparoscopic pyeloplasty requires advanced laparoscopic skills related to intracorporeal suturing. However, the learning curve of suturing in robotics is much shorter compared with laparoscopy. In fact, during LP, the authors have to place 2-3 transabdominal stay sutures to stabilize the uretero-pelvic junction, before performing the anastomosis. Conversely, the authors never needed to place stay sutures in RALP. CONCLUSIONS The study experience suggested that RALP and LP give excellent results in children with UPJO. Laparoscopic pyeloplasty can be considered more minimally invasive than RALP because 3-mm trocars are adopted instead of 8-mm robotic ports. However, LP is technically challenging and has a bad ergonomics for the surgeon. Conversely, RALP is technically easier compared with LP, especially in redo procedures, with an excellent ergonomics. The main disadvantages of RALP remain high costs and size of robotic instruments. The choice to perform LP or RALP should be tailored to the individual case, considering patient's age and surgeon's experience.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.
| | - Lorenzo Masieri
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Medical University of Padua, Padua, Italy
| | - Simone Sforza
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - Alessandra Farina
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Chiara Cini
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - Fulvia Del Conte
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
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[
Robotic pyeloplasty: the results after the first 30 patients]. Urologia 2014; 81 Suppl 23:S24-6. [PMID: 24665029 DOI: 10.5301/ru.2014.11982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this paper is to report the outcomes of 30 (first) robot-assisted pyeloplasties (RPs) performed at our institute for the treatment of ureteropelvic junction obstruction (UPJO).
METHODS In the period between March 2005 and September 2012, 30 RPs due to UPJO have been performed at our institute using a three arms Da Vinci Robot, standard version. All the procedures were performed transperitoneally with Anderson-Hynes technique. 29/30 (97%) patients were affected by primary UPJO and 1/30 (3%) reported a recurrent disease. The access foresaw the positioning of three robotic trocars (one 12 mm trocar for the camera and two 8-mm trocars for the robotic arms) and one assistant 12 mm trocar. The anastomosis was confectioned on a double-J ureteral tutor with 4/0 monocryl running sutures. Outcome success was defined as resolution of preoperative symptoms and ureteropelvic junction obstruction, confirmed by the improvement of the diuretic renogram. Mean follow-up was 48.3 months (range 5-96).
RESULTS All procedures have been completed robotically and no conversion was needed.
Mean operative times, blood losses and hospital stay were respectively 189 minutes (range 105-420), 60 mL (range 25-100) and 4.2 days (range 2-14).
29/30 patients were cured, with a success rate of 97%.
As regards mild complications, 3/30 patients (10%) reported a moderate abdominal pain a few hours after surgery, which was successfully treated with common analgesic drugs.
A s for major complications, one patient (3%) developed ileus, probably due to a mild urine extravasation through the ureteropelvic suture, which spontaneously disappeared three days after surgery.
CONCLUSION RP seems to be a "new gold standard" in the treatment of UPJO.
The three-dimensional versatility and the outstanding accuracy of robot-assisted intracorporeal suturing produced excellent results after the first procedures without requiring a previous 'sound' laparoscopic experience.
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Chaussy Y, Becmeur F, Lardy H, Aubert D. Robot-Assisted Surgery: Current Status Evaluation in Abdominal and Urological Pediatric Surgery. J Laparoendosc Adv Surg Tech A 2013; 23:530-8. [DOI: 10.1089/lap.2012.0192] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Yann Chaussy
- Department of Pediatric Surgery, Hospital Saint-Jacques, Centre Hospitalier Regional Universitaire de Besançon, Besançon, France
| | - François Becmeur
- Department of Pediatric Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Clocheville Hospital, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | - Didier Aubert
- Department of Pediatric Surgery, Hospital Saint-Jacques, Centre Hospitalier Regional Universitaire de Besançon, Besançon, France
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Abstract
PURPOSE OF REVIEW Minimally invasive surgeries such as conventional laparoscopic surgery and robotic assisted laparoscopic surgery (RALS) have significant advantages over the traditional open surgical approach including lower pain medication requirements and decreased length of hospitalization. However, open surgery has demonstrated better success rates and shorter surgery time when compared to the other modalities. Currently, it is unclear which approach has better long-term clinical outcomes, greater benefits and less cost. RECENT FINDINGS There are limited studies in the literature comparing these three different surgical approaches. In this review, we will evaluate the advantages and disadvantages of RALS compared to conventional laparoscopic surgery and open surgery for commonly performed pediatric urological procedures such as pyeloplasty, ureteral reimplantation, complete and partial nephrectomy, bladder augmentation and creation of continent catheterizable channels. SUMMARY Although it is not yet possible to demonstrate the superiority of one single surgical modality over another, RALS has been shown to be feasible, well tolerated and advantageous in reconstructive urological procedures. With experience, the outcomes of RALS are improving, justifying its usage. However, cost remains a significant issue, limiting the accessibility of RALS, which in the future may improve with market competition and device innovation.
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Fiori C, Morra I, Bertolo R, Mele F, Chiarissi ML, Porpiglia F. Standard vs mini-laparoscopic pyeloplasty: perioperative outcomes and cosmetic results. BJU Int 2012; 111:E121-6. [DOI: 10.1111/j.1464-410x.2012.11376.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[Robotic surgery in paediatric urology: current status and perspectives]. Urologe A 2011; 50:1297-300. [PMID: 21728010 DOI: 10.1007/s00120-011-2624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The increasing experience obtained through laparoscopy has resulted in the evolution of ablative and reconstructive procedures in the field of paediatric urology. Apart from the established methods of laparoscopic nephrectomy and orchidopexy, nowadays laparoscopic hemi-nephrectomy and pyeloplasty have become standard therapeutic surgical alternatives. Nevertheless, many of these procedures require a high level of experience in laparoscopic preparation and stitching techniques and are thus performed in institutions with greater laparoscopic experience. With the introduction and evolution of the robotic-assisted technique and the availability of smaller instruments and ports (8 and 5 mm), there has been an evolution in the spectrum of complex ablative and reconstructive procedures in the field of paediatric urology as well. Nevertheless, there is a lack of randomised trails and the literature available in this area consists manly of case reports. The purpose of this article is to present the current status and perspectives of robotic-assisted surgery in the field of paediatric urology.
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Wayment RO, Waller CJ, Kramer BA, Schwartz BF. Intraoperative Cystoscopic Stent Placement in Robot-Assisted Pyeloplasty: A Novel and Efficient Technique. J Endourol 2009; 23:583-6; discussion 586-7. [DOI: 10.1089/end.2008.0546] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert O. Wayment
- Division of Urology, Southern Illinois University, Springfield, Illinois
| | | | - Brandan A. Kramer
- Division of Urology, Southern Illinois University, Springfield, Illinois
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Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH, John H. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 2008; 23:438-43. [PMID: 19037694 DOI: 10.1007/s00464-008-0202-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 10/13/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments. METHODS At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i-v):1-88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa. RESULTS As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci((R)): 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324 ). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics. CONCLUSION While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.
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Affiliation(s)
- Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
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Kim C, Campbell B, Ferrer F. Robotic sigmoid vaginoplasty: a novel technique. Urology 2008; 72:847-9. [PMID: 18502481 DOI: 10.1016/j.urology.2008.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 02/25/2008] [Accepted: 04/03/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We describe an innovative approach to sigmoid vaginoplasty that uses robotic-assisted laparoscopy and 1 perineal incision. METHODS Our patient is a 17-year-old 46 XY adolescent. This patient had surgery performed in July 2007. The procedure was performed through 1 camera port and 3 working ports. RESULTS The intra-abdominal portion of surgery was performed entirely with a Davinci S robot (Intuitive Surgical, Sunnyvale, CA). The total time in the operating room was 9 hours and 45 minutes. The patient was discharged home on postoperative day 4. On follow-up at 10 months, the patient is dilating successfully with no complications. CONCLUSIONS The use of minimally invasive surgery continues to grow and evolve. This case represents the first reported robotically assisted laparoscopic sigmoid vaginoplasty. The favorable results support its use as another option for a challenging surgery in which cosmetic results are so important.
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Affiliation(s)
- Christina Kim
- Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
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Porpiglia F, Billia M, Volpe A, Morra I, Scarpa RM. Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi-ureteric junction: technique description and results with a minimum follow-up of 1 year. BJU Int 2007; 101:1024-8. [DOI: 10.1111/j.1464-410x.2007.07323.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zafar N, Leyland J, Shah NC. Laparoscopic pyeloplasty in a solitary kidney. NATURE CLINICAL PRACTICE. UROLOGY 2007; 4:625-629. [PMID: 17982439 DOI: 10.1038/ncpuro0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 09/03/2007] [Indexed: 05/25/2023]
Abstract
BACKGROUND A 40-year-old male presented with right-sided abdominal pain and no lower urinary tract symptoms. Examination was unremarkable, apart from mild right renal angle tenderness. INVESTIGATIONS Renal function, full blood count and C-reactive protein levels were all normal. Ultrasound of renal tract, abdominal computed tomography (CT) and (99m)Tc-mercaptoacetyltriglycine (MAG3) renogram confirmed ureteropelvic junction obstruction. DIAGNOSIS The ureteropelvic junction obstruction of the right kidney was identified, with a crossing lower pole renal vessel as the possible cause. An absent left kidney was also noted. MANAGEMENT Laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty was performed, with posterior transposition of the crossing lower pole vessel.
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Affiliation(s)
- Nauman Zafar
- Urology Department, Addenbrookes Hospital, Cambridge, UK
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Abstract
The prevalence of vesicoureteral reflux (VUR) has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.
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Affiliation(s)
- Atul A Thakre
- Division of Pediatric Surgery and Pediatric Urology, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
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Abstract
BACKGROUND Laparoscopic pyeolplasty has become a minimally invasive alternative to open pyeloplasty. Due to technical concerns with intracorporeal suturing, robotic pyeloplasty has become an emerging alternative. METHODS The literature was reviewed for reports and outcomes on robotic pyeloplasty. RESULTS Reports of robotic pyeloplasty are increasing, and outcomes appear excellent. CONCLUSIONS Robotic pyeloplasty is feasible with excellent outcomes. Challenges remain in making the procedure cost effective.
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Affiliation(s)
- K Badwan
- Division of Urology, Washington University Medical Centre, St. Louis, MO 63110, USA
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