Comparative study of open and robot-assisted approaches to ureteropelvic junction obstruction in children ≤ 12 months: A multi-institutional retrospective analysis.
Suhaib Abdulfattah, Aznive Aghababian, Sahar Eftekharzadeh, Meghan Davis, Iqra Nadeem, Sonam Saxena, Nicole J Kye, John Weaver, Hannah Bachtel, Catherine T Nguyen, Elizabeth Khusid, Christina Sze, Tenny Zhang, Kiersten Craig, Monica Xing, Katherine Fischer, Karl Godlewski, Shuvro De, Ricardo Arceo-Olaiz, Christopher Long, Dana Weiss, Chester J Koh, Ardavan Akhavan, Mohan Gundeti, Andrew J Kirsch, Arun K Srinivasan, Aseem R Shukla, Sameer Mittal
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引用次数: 0
Abstract
Background: The utilization of robot-assisted laparoscopic pyeloplasty (RALP) for the surgical correction of ureteropelvic junction obstruction (UPJO) continues to increase. The aim of this study was to determine whether robot-assisted laparoscopic pyeloplasty (RALP) is a safe and equally efficacious procedure compared to open pyeloplasty (OP) in infants ≤12 months old.
Methods: All patients ≤12 months old who underwent RALP or OP between January 2012 and January 2021 at five participating centers were included in this study. Patients who had pure laparoscopic approach, redo-pyeloplasty, ureterocalicostomy, abnormal nephro-ureteral anomalies, or lacked reviewable surgical records were excluded. Success was defined as lack of advanced endoscopic or re-do reconstructive intervention.
Results: 448 out of 497 patients met inclusion criteria: 151 RALP (34 %) and 297 OP (66 %). The median age at surgery was similar for both cohorts (p = 0.29). RALP compared to OP was associated with a higher usage of ureteral stent placement (100 % vs 88.9 %; p < 0.001) and longer procedure time (175 vs 160 min; p = 0.01), less administration of hospital morphine-equivalents post-operatively (p < 0.001) and similar length of stay (p = 0.96). There was no difference in the incidence of 30-day complications between the two groups, however higher-grade complications were seen in the OP group. Over a median follow of 26 months, the success rate after RALP and OP was 98.7 % and 89.6 % respectively (p < 0.001).
Conclusion: In this large, multi-institutional comparative series of infant pyeloplasty, our results demonstrate that RALP is not only safe and feasible, but also confers the advantages of reduced opioid usage, decreased risk of high-grade complications and decreased need for additional interventions during follow-up.
期刊介绍：
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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