Journal of pediatric urology · 2025
Comparative study of open and robot-assisted approaches to ureteropelvic junction obstruction in children ≤ 12 months: A multi-institutional retrospective analysis.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Abdulfattah Suhaib, Aghababian Aznive, Eftekharzadeh Sahar, Davis Meghan, Nadeem Iqra, Saxena Sonam, Kye Nicole J, Weaver John, Bachtel Hannah, Nguyen Catherine T, Khusid Elizabeth, Sze Christina, Zhang Tenny, Craig Kiersten, Xing Monica, Fischer Katherine, Godlewski Karl, De Shuvro, Arceo-Olaiz Ricardo, Long Christopher, Weiss Dana, Koh Chester J, Akhavan Ardavan, Gundeti Mohan, Kirsch Andrew J, Srinivasan Arun K, Shukla Aseem R, Mittal Sameer
Аннотация
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.
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.