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Published on: July 19, 2021
Safety and Efficacy of Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair in Infants under 1 Year of Age
James T Rague1, Hans C Arora1, David I Chu1,2
1Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Insights
Robot-assisted laparoscopic pyeloplasty (RALP) is a safe and effective alternative to open pyeloplasty (OP) in infants. Both procedures show comparable outcomes regarding complications, radiographic improvement, and reoperation rates.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Robot-assisted laparoscopic pyeloplasty (RALP) adoption is increasing in pediatric surgery.
- Open pyeloplasty (OP) remains a preferred method in infants at many institutions.
- Comparative data on RALP versus OP in infants is crucial for surgical decision-making.
Purpose of the Study:
- To compare the safety and efficacy of RALP and OP in infants.
- To evaluate intraoperative and short-term postoperative outcomes.
- To assess long-term success rates and the need for revision surgery.
Main Methods:
- Retrospective cohort study of infants (<1 year) undergoing primary pyeloplasty (RALP or OP).
- Analysis of intraoperative/30-day complications, radiographic improvement, and operative failure.
- Multivariable logistic regression and survival analysis were employed.
Main Results:
- 91.1% RALP patients and 88.8% OP patients achieved radiographic improvement.
- RALP showed a trend towards fewer 30-day complications (OR 0.40, not significant).
- No significant difference in time to operative failure or need for redo pyeloplasty between RALP and OP.
Conclusions:
- Robot-assisted laparoscopic pyeloplasty (RALP) is a safe and effective option for infant pyeloplasty.
- RALP offers comparable outcomes to open pyeloplasty (OP) in terms of complications and success rates.
- The choice between RALP and OP in infants should consider these comparable outcomes.
Purpose:
Robot-assisted laparoscopic pyeloplasty (RALP) use in children has increased, though many centers still favor open pyeloplasty (OP) in infants. This study aims to compare safety and efficacy of RALP and OP in infants.
Materials And Methods:
A single-institution, retrospective cohort study of infants <1 year of age who underwent primary RALP or OP between January 2009 and June 2020 was performed. Primary outcomes were intraoperative and 30-day complications, postoperative radiographic improvement at last clinic visit, and operative failure leading to redo pyeloplasty. Multivariable logistic regression was performed for 30-day complications to adjust for demographic variation between groups. Survival analysis was performed to compare time to diagnosis of operative failure leading to redo pyeloplasty.
Results:
Among 204 patients, 121 underwent OP and 83 underwent RALP (74.5% male). RALP patients were older (median 7.2 vs 2.9 months, p <0.001) and larger (median 8.2 vs 5.9 kg, p <0.001) than OP patients. Radiographic improvement was seen in 91.1% of RALP patients and 88.8% of OP patients at last visit. Median (interquartile range) followup in months was 24.4 (10.8-50.3) for the full cohort. In adjusted analysis, the odds of a 30-day complication (OR 0.40, 95% CI 0.08-2.00) was lower for RALP compared to OP, though not statistically significant. In survival analysis, there was no difference in time to diagnosis of operative failure and redo pyeloplasty between groups (p=0.65).
Conclusions:
RALP is a safe and effective alternative to OP for infants, with comparable intraoperative and 30-day complications, radiographic improvement at last followup, and risk of pyeloplasty failure.
