Robotic Versus Laparoscopic Technique for Ureteropelvic Junction Obstruction Treatment in Children: A Comparative
Carlo Maria Ferlini1, Giulia Fusi1, Michela Marinaro1
1Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
Robotic-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) show similar safety and effectiveness for pediatric ureteropelvic junction obstruction. Surgeon preference and robot availability may guide technique selection for this minimally invasive surgery.
Area of Science:
- Urology
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic pyeloplasty (LP) offers benefits for pediatric ureteropelvic junction obstruction (UPJO) but has a steep learning curve.
- Robotic-assisted laparoscopic pyeloplasty (RALP) reduces technical complexity but increases costs, with no established superiority over LP.
- Comparative data on the safety and efficacy of LP versus RALP in pediatric UPJO is limited.
Purpose of the Study:
- To compare the outcomes of robotic-assisted laparoscopic pyeloplasty (RALP) versus laparoscopic pyeloplasty (LP) in pediatric patients.
- To evaluate safety, efficacy, complications, and need for re-operation in minimally invasive pyeloplasty techniques.
Main Methods:
- Retrospective comparative cohort study at two tertiary centers.
- Inclusion of pediatric patients undergoing LP (London) or RALP (Pavia) for UPJO.
- Analysis of preoperative, intraoperative, and postoperative data, including complications and symptom resolution.
Main Results:
- 75 patients (47 LP, 28 RALP) with similar preoperative characteristics.
- Anderson-Hynes technique used in 94.7% with universal stenting; no conversions.
- Comparable complication rates (12.7% LP vs. 25.0% RALP) and redo surgery rates (6.4% LP vs. 3.6% RALP), not statistically significant.
Conclusions:
- RALP and LP demonstrate comparable safety and efficacy for pediatric UPJO treatment.
- Symptom resolution and reduction in pelvic diameter were similar between both techniques.
- Choice between RALP and LP may depend on surgeon expertise and robotic system availability.
Introduction:
Laparoscopic pyeloplasty (LP) for treatment of ureteropelvic junction obstruction (UPJO) in children offers advantages over open surgical correction, including reduced hospitalization times and lower perioperative morbidity, but presents a long learning curve. Robotic-assisted laparoscopic pyeloplasty (RALP) offers the same advantages with reduced technical operative complexity but entails higher costs. No clear superiority of laparoscopy versus robotic surgery has been established.
Materials And Methods:
We conducted a retrospective comparative cohort study including pediatric patients who underwent minimally invasive pyeloplasty at two tertiary-level centers, those at Evelina Children's Hospital in London (UK) receiving LP and those at Policlinico San Matteo in Pavia (Italy) undergoing RALP. Data concerning preoperative variables and obstruction severity; intraoperative variables and surgical techniques; degree of postoperative obstruction reduction, complications, and redo surgeries were analysed.
Results:
A total of 75 patients were included, with 47 undergoing LP and 28 receiving RALP, with similar preoperative characteristics across groups. The Anderson-Hynes surgical technique was employed in 71/75 cases (94.7%) with universal stent use. No conversions were recorded. Mean operatives times and postoperative length of stay were longer for RALP. Complications took place in 7/28 (25.0%) of RALP patients and 6/47 (12.7%) of LP patients. Redo surgery was needed for 1/28 (3.6%) RALP and 3/47 (6.4%) LP patients. These differences were not statistically significant. Symptoms resolution and postoperative pelvic diameter decrease were comparable between groups.
Conclusions:
RALP and LP appeared comparable in terms of safety and efficacy. Adoption of one technique over the other may be justified by the surgeon's preference and the availability of a robot.
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