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Systematic Review and Meta-Analysis of Pediatric Robot-Assisted Laparoscopic Pyeloplasty.
David Greenwald1, Amrita Mohanty1, Ciro Andolfi1
1Pediatric Urology, Section of Urology, Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Comer Children's Hospital Chicago, IL, USA.
Journal of Endourology
|November 22, 2021
Summary
Robot-assisted laparoscopic pyeloplasty (RALP) shows a high success rate of 95.4% for pediatric ureteropelvic junction obstruction. While effective, further research is needed to compare RALP with other surgical approaches.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in children.
- Robot-assisted laparoscopic pyeloplasty (RALP) is an increasingly utilized surgical technique for UPJ obstruction.
- Evidence regarding the outcomes of RALP in pediatric populations requires systematic evaluation.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of outcomes associated with robot-assisted laparoscopic pyeloplasty (RALP) in children with ureteropelvic junction (UPJ) obstruction.
- To synthesize current evidence on surgical techniques, perioperative outcomes, success rates, and complications of pediatric RALP.
Main Methods:
- A systematic review of English-language literature was performed using MEDLINE, EMBASE, and Cochrane databases (July 2020).
- Included studies focused on surgical techniques and perioperative outcomes of RALP for UPJ obstruction in children.
- Forty-six studies were included in the meta-analysis, with evidence quality assessed using the Modified Newcastle-Ottawa Scale.
Main Results:
- The mean success rate for RALP in pediatric UPJ obstruction was 95.4% (95% CI: 91.0%-99.3%).
- The majority of studies reported a short length of stay (approximately 1 day).
- The overall mean complication rate was 12%, with a mean low-grade (Clavien Grade ≤2) complication rate of 9.3% and a mean high-grade (Clavien Grade ≥3) complication rate of 6.5%.
Conclusions:
- Robot-assisted surgery is technically feasible and demonstrates favorable outcomes for pediatric pyeloplasty.
- The current evidence base is largely derived from retrospective, single-institution studies, introducing potential biases.
- Further prospective, multi-institutional studies with standardized reporting are recommended to definitively establish the benefits and limitations of RALP compared to open and laparoscopic approaches.
