Abstract
Objective: To investigate the outcomes of minimally invasive approach to infants with ureteropelvic junction (UPJ) obstruction by comparing the two surgical modalities of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP).Methods: We conducted a retrospective review of all consecutive infants aged ≤12 months who underwent either LP or RALP in a single institution over the period of 2008–Jul 2020. We included primary pyeloplasty cases that were performed by or under the supervision of the same surgeon.Results: Forty-six infants (LP = 22; RALP = 24) were included with medians of age and body weight at 6 months (2–12months) and 8.0 kg (5.4–10 kg), respectively. There was no difference between the two groups in the patients' demographics and pre-operative characteristics. All infants underwent LP or RALP successfully without conversion to open surgery. None had intraoperative complications. Operative time (OT) was 242 min (SD = 59) in LP, compared with 225 min (SD = 39) of RALP (p = 0.25). Linear regression analysis showed a significant trend of decrease in OT with increasing case experience of RALP(p = 0.005). No difference was noted in the post-operative analgesic requirement. RALP was associated with a shorter hospital length of stay than LP (3 vs. 3.8 days; p = 0.009). 4/22(18%) LP and 3/24(13%) RALP developed post-operative complications (p = 0.59), mostly minor and stent-related. The success rates were 20/22 (91%) in LP and 23/24 (96%) in RALP (p = 0.49).Conclusions: Pyeloplasty by minimally invasive approach is safe and effective in the infant population. RALP may have superiority over LP in infants with its faster recovery and a more manageable learning curve to acquire the skills.
Highlights
Previous studies of meta-analysis have shown that both laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) are viable options to treat ureteropelvic junction (UPJ) obstruction in children with the benefits of shorter hospital stay and decreased morbidity while maintaining a success rate comparable to open pyeloplasty (OP) [1,2,3].RALP vs. LP in InfantsThe contemporary evidence of performing pyeloplasty by minimally invasive approach in the infant population, are less robust than in older children as there are few comparative studies ever published [4,5,6].The expanding interest in minimally invasive pyeloplasty in children is mainly brought by the momentum of the robotic technology
National trends study in the United States between 2003 and 2015 showed that LP decreased annually by a rate of 12% while RALP grew by 29% annually [7]
After getting the approval of the clinical research ethics committee of our institution, we retrospectively reviewed the medical records of all consecutive infants aged 12 months or less who underwent either LP or RALP for UPJ obstruction in our institution over the period of 2008–July 2020
Summary
Previous studies of meta-analysis have shown that both laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) are viable options to treat ureteropelvic junction (UPJ) obstruction in children with the benefits of shorter hospital stay and decreased morbidity while maintaining a success rate comparable to open pyeloplasty (OP) [1,2,3].RALP vs. LP in InfantsThe contemporary evidence of performing pyeloplasty by minimally invasive approach in the infant population, are less robust than in older children as there are few comparative studies ever published [4,5,6].The expanding interest in minimally invasive pyeloplasty in children is mainly brought by the momentum of the robotic technology. Previous studies of meta-analysis have shown that both laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) are viable options to treat ureteropelvic junction (UPJ) obstruction in children with the benefits of shorter hospital stay and decreased morbidity while maintaining a success rate comparable to open pyeloplasty (OP) [1,2,3]. The contemporary evidence of performing pyeloplasty by minimally invasive approach in the infant population, are less robust than in older children as there are few comparative studies ever published [4,5,6]. A big contrast, was noted in the infant population in which 85% of cases were OP while RALP and LP accounted for 10 and 5%, respectively in 2015 [7]. Infants were excluded in some of the comparative studies [9, 10]
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