PDF(Pubmed)
Abstract：
UNASSIGNED: This study aims to analyze the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO) over a 10-year period at a tertiary care center in South India.
UNASSIGNED: This study provides a detailed analysis of prospectively acquired data from 2013 to 2023 of all children who underwent RALP at our institution. Pre- and post-operative renal ultrasound and isotope renography were used to assess outcomes. Detailed information on patient demographics, procedural duration, post-operative pain relief, operation steps, and post-surgical follow-up protocols has been provided. The analysis included all patients who completed a 1-year follow-up.
UNASSIGNED: Between 2013 and 2023, 201 children underwent RALP. Of these, 185 children completed at least 1 year of follow-up and were included in the analysis. The mean age of the cohort was 4.9 years (1 month to 17 years), with males comprising the majority (77.3%). Twenty-five children (13.5%) were younger than 1 year of age. Left-sided PUJO was found to be more common. The mean console time was 76.5 min (40-180 min), and the average hospital stay was 2.8 days (2-5). After surgery, the mean reduction in antero-posterior diameter of the renal pelvis was more than 50% of its pre-operative value and statistically significant (3.3 ± 0.3 to 1.9 ± 0.9 cm). At the end of 1 year, the overall reduction in renal size was also significant (9.7 ± 2.3 cm pre-operative to 8.9 ± 1.8 cm post-operative). The pre-operative Society of Fetal Urology (SFU) grade of hydronephrosis was compared to the post-operative SFU grade, and the improvement (resolution/downgrading) was found to be statistically significant. The median split renal function in this series was 39% pre-operative and 43% post-operative, and the overall functional improvement after RALP was significant. A successful outcome was observed in 181 children (97.8%). Four children experienced persistent severe hydronephrosis and underwent redo stenting and/or redo pyeloplasty (2.1% failure rate). Post-operative complications, according to the Clavien-Dindo classification, were classified as type 1 in three children and type 3b in two children. There were no conversions to open surgery in the series.
UNASSIGNED: RALP emerges as the minimally invasive procedure of choice for children with PUJO at our institution. It is safe, delivering consistently excellent results and minimal complications. Our outcomes are comparable to those of previously published series. We trust that our experience will serve as a roadmap for those centers (especially in South Asia) embarking on a pediatric robotic program.
UNASSIGNED: This study provides a detailed analysis of prospectively acquired data from 2013 to 2023 of all children who underwent RALP at our institution. Pre- and post-operative renal ultrasound and isotope renography were used to assess outcomes. Detailed information on patient demographics, procedural duration, post-operative pain relief, operation steps, and post-surgical follow-up protocols has been provided. The analysis included all patients who completed a 1-year follow-up.
UNASSIGNED: Between 2013 and 2023, 201 children underwent RALP. Of these, 185 children completed at least 1 year of follow-up and were included in the analysis. The mean age of the cohort was 4.9 years (1 month to 17 years), with males comprising the majority (77.3%). Twenty-five children (13.5%) were younger than 1 year of age. Left-sided PUJO was found to be more common. The mean console time was 76.5 min (40-180 min), and the average hospital stay was 2.8 days (2-5). After surgery, the mean reduction in antero-posterior diameter of the renal pelvis was more than 50% of its pre-operative value and statistically significant (3.3 ± 0.3 to 1.9 ± 0.9 cm). At the end of 1 year, the overall reduction in renal size was also significant (9.7 ± 2.3 cm pre-operative to 8.9 ± 1.8 cm post-operative). The pre-operative Society of Fetal Urology (SFU) grade of hydronephrosis was compared to the post-operative SFU grade, and the improvement (resolution/downgrading) was found to be statistically significant. The median split renal function in this series was 39% pre-operative and 43% post-operative, and the overall functional improvement after RALP was significant. A successful outcome was observed in 181 children (97.8%). Four children experienced persistent severe hydronephrosis and underwent redo stenting and/or redo pyeloplasty (2.1% failure rate). Post-operative complications, according to the Clavien-Dindo classification, were classified as type 1 in three children and type 3b in two children. There were no conversions to open surgery in the series.
UNASSIGNED: RALP emerges as the minimally invasive procedure of choice for children with PUJO at our institution. It is safe, delivering consistently excellent results and minimal complications. Our outcomes are comparable to those of previously published series. We trust that our experience will serve as a roadmap for those centers (especially in South Asia) embarking on a pediatric robotic program.
摘要：
■本研究旨在分析机器人辅助腹腔镜肾盂成形术（RALP）在印度南部三级护理中心的10年期间对患有骨盆-输尿管交界处梗阻（PUJO）的儿童的结果。
■这项研究对2013年至2023年在我们机构接受RALP的所有儿童的前瞻性获得的数据进行了详细分析。术前和术后肾脏超声和同位素肾图用于评估结果。患者人口统计的详细信息，程序持续时间,术后疼痛缓解,操作步骤,并提供了术后随访方案。分析包括所有完成1年随访的患者。
■在2013年至2023年之间，有201名儿童接受了RALP。其中,185名儿童完成了至少1年的随访，并被纳入分析。该队列的平均年龄为4.9岁（1个月至17岁），男性占多数(77.3%)。25名儿童（13.5％）小于1岁。发现左侧PUJO更为常见。平均控制台时间为76.5分钟（40-180分钟），平均住院时间为2.8天（2-5天）。手术后,肾盂前后径的平均减少超过术前值的50%,且有统计学意义(3.3±0.3~1.9±0.9cm).一年结束时,肾脏大小的整体缩小也是显著的(术前为9.7±2.3cm,术后为8.9±1.8cm).术前胎儿泌尿外科学会(SFU)肾积水分级与术后SFU分级进行比较,并且发现改善（分辨率/降级）具有统计学意义。该系列中的中位分裂肾功能为术前39%和术后43%,RALP后整体功能改善显著。在181名儿童中观察到成功的结果（97.8％）。四名儿童经历了持续性严重肾积水，并接受了重新置入支架和/或重新进行肾盂成形术（失败率为2.1％）。术后并发症,根据Clavien-Dindo分类，3名儿童被分类为1型，2名儿童被分类为3b型。该系列中没有转换为开放手术。
■RALP成为我们机构PUJO儿童的微创手术选择。它是安全的,提供一贯优异的结果和最小的并发症。我们的结果与以前出版的系列相当。我们相信，我们的经验将成为这些中心（尤其是在南亚）开展儿科机器人计划的路线图。
■这项研究对2013年至2023年在我们机构接受RALP的所有儿童的前瞻性获得的数据进行了详细分析。术前和术后肾脏超声和同位素肾图用于评估结果。患者人口统计的详细信息，程序持续时间,术后疼痛缓解,操作步骤,并提供了术后随访方案。分析包括所有完成1年随访的患者。
■在2013年至2023年之间，有201名儿童接受了RALP。其中,185名儿童完成了至少1年的随访，并被纳入分析。该队列的平均年龄为4.9岁（1个月至17岁），男性占多数(77.3%)。25名儿童（13.5％）小于1岁。发现左侧PUJO更为常见。平均控制台时间为76.5分钟（40-180分钟），平均住院时间为2.8天（2-5天）。手术后,肾盂前后径的平均减少超过术前值的50%,且有统计学意义(3.3±0.3~1.9±0.9cm).一年结束时,肾脏大小的整体缩小也是显著的(术前为9.7±2.3cm,术后为8.9±1.8cm).术前胎儿泌尿外科学会(SFU)肾积水分级与术后SFU分级进行比较,并且发现改善（分辨率/降级）具有统计学意义。该系列中的中位分裂肾功能为术前39%和术后43%,RALP后整体功能改善显著。在181名儿童中观察到成功的结果（97.8％）。四名儿童经历了持续性严重肾积水，并接受了重新置入支架和/或重新进行肾盂成形术（失败率为2.1％）。术后并发症,根据Clavien-Dindo分类，3名儿童被分类为1型，2名儿童被分类为3b型。该系列中没有转换为开放手术。
■RALP成为我们机构PUJO儿童的微创手术选择。它是安全的,提供一贯优异的结果和最小的并发症。我们的结果与以前出版的系列相当。我们相信，我们的经验将成为这些中心（尤其是在南亚）开展儿科机器人计划的路线图。
