■机器人辅助腹腔镜肾盂成形术(RALP)已获得儿科泌尿科医师的认可。
■为了比较手术变量和临床结果,包括并发症和成功率,使用经腹膜(T-RALP)和腹膜后(R-RALP)方法进行RALP。
■我们执行了多中心,prospective,2016年11月至2021年10月在三个儿科泌尿外科教学中心进行的队列研究(NCT03274050)(经腹膜入路,n=2;腹膜后入路,n=1)。通过肾脏超声和巯基乙酰三甘氨酸-3肾脏扫描或功能评估的尿磁共振成像证实了肾盂输尿管连接梗阻(UPJO)的诊断。排除标准为<2岁的儿童,肾盂成形术失败后持续性UPJO,马蹄铁和异位肾。
■我们使用运行的单丝6-0可吸收缝合线进行了离断性肾盂成形术。
■我们评估了术中和术后的发病率(主要结果)和成功率(次要结果)。数据以定量变量的中位数和四分位数间距(第25和第75百分位数)表示,并进行了比较分析。
■我们对106名儿童进行了手术(T-RALP,n=53;R-RALP,n=53)。术前数据在组间具有可比性(中位年龄9.1[6.2-11.2]岁;中位体重26.8[21-40]kg)。设置时间(10对31分钟),吻合时间(49vs73分钟),与R-RALP相比,T-RALP的控制台时间(97vs153分钟)明显缩短(p<0.001)。术中无并发症发生。没有必要转换为开放手术。T-RALP后的中位住院时间(2d)长于R-RALP后的中位住院时间(1d;p<0.001)。总的来说,术后并发症发生率相似.在平均随访25.4(15.1-34.7)个月时,没有发生失败。
■在选定的子项中,RALP使用经腹膜或腹膜后入路都是安全有效的,R-RALP后住院时间较短。
■在我们的多中心,前瞻性研究,我们比较了经腹膜和腹膜后入路机器人辅助腹腔镜肾盂成形术(RALP)的结果和并发症.我们发现RALP使用两种方法都是安全有效的,R-RALP后住院时间较短。
UNASSIGNED: Robotic-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among paediatric urologists.
UNASSIGNED: To compare surgical variables and clinical outcomes, including complications and success rate, with RALP using the transperitoneal (T-RALP) and
retroperitoneal (R-RALP) approaches.
UNASSIGNED: We performed a multicentre, prospective, cohort
study (NCT03274050) between November 2016 and October 2021 in three paediatric urology teaching centres (transperitoneal approach, n = 2;
retroperitoneal approach, n = 1). The diagnosis of ureteropelvic junction obstruction (UPJO) was confirmed by renal ultrasound and mercaptoacetyltriglycine-3 renal scan or uro-magnetic resonance imaging with functional evaluation. The exclusion criteria were children <2 yr old, persistent UPJO after failed pyeloplasty, and horseshoe and ectopic kidney.
UNASSIGNED: We performed dismembered pyeloplasty using running monofilament 6-0 absorbable suture.
UNASSIGNED: We assessed intra- and postoperative morbidity (primary outcome) and success (secondary outcome). Data were expressed as medians and interquartile range (25th and 75th percentiles) for quantitative variables, and analysed comparatively.
UNASSIGNED: We operated on 106 children (T-RALP, n = 53; R-RALP, n = 53). Preoperative data were comparable between groups (median age 9.1 [6.2-11.2] yr; median weight 26.8 [21-40] kg). Set-up time (10 vs 31 min), anastomotic time (49 vs 73 min), and console time (97 vs 153 min) were significantly shorter with T-RALP than with R-RALP (p < 0.001). No intraoperative complications occurred. No conversion to open surgery was necessary. The median hospital stay was longer after T-RALP (2 d) than after R-RALP (1 d; p < 0.001). Overall, postoperative complication rates were similar. No failure had occurred at the mean follow-up of 25.4 (15.1-34.7) mo.
UNASSIGNED: In selected children, RALP is safe and effective using either the transperitoneal or the retroperitoneal approach, with a shorter hospital stay after R-RALP.
UNASSIGNED: In our multicentre, prospective
study, we compared the results and complications of robotic-assisted laparoscopic pyeloplasty (RALP) using the transperitoneal and
retroperitoneal approaches. We found that RALP is safe and effective using either approach, with a shorter hospital stay after R-RALP.