Comparison of hidden incision endoscopic surgery and traditional port placement for robotic assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction
Liu Dehong1, Zhou Huixia1, Liu Yujing2, Ma Lifei1, Cao Hualin1, Zhou Xiaoguang1, Tao Tian1, Hao Xuemei3
1Department of Medical Engineering, the PLA Army General Hospital, Beijing 100700, China; 2Department of Urology, Bayi Children's Hospital Affiliated to the PLA Army General Hospital; 3Department of Anesthesiology, the PLA Army General Hospital
Abstract：Objective: To compare the efficacy and safety of hidden incision endoscopic surgery (HIdES) vs. traditional port placement (TPP) for robot-assisted laparoscopic pyeloplasty (RALP) in children ureteropelvic junction obstruction. Methods: The clinical data of 37 children who underwent RALP between 21 March 2017 and 30 June 2017 were reviewed. TPP for RALP was performed on 15 cases (TPP group), and HIdES for RALP was performed on 22 cases (HIdES group). We assessed preoperative clinical data and outcomes, and analyzed the transition experience. Data were expressed as medians for continuous variables. Results: All operations were successful with no serious intraoperative complication. There were no significant differences in demographics and clinical presentation between two groups (P>0.05). There were no significant differences in operative time, drain removal, start of oral feeding and hospital stay between HIdES group and TPP group (P>0.05). However, there was significant difference in Clavien Ⅰ and Ⅱ complications postoperatively between HIdES group and TPP group (P<0.05), and the cosmetic result of HIdES group was better than that of TPP group. Conclusions: HIdES and TPP for RALP in children with UPJO are safe and efficient procedures with equivalent success rate. However, HIdES for RALP may have the advantages of convenient operation and cosmetic result. We propose that HIdES for RALP is potentially a recommended feasible treatment option for children with UPJO.
刘宇静, 刘德鸿, 周辉霞, 马立飞, 曹华林, 周晓光, 陶天, 郝雪梅. 隐匿切口法与传统通道法机器人辅助腹腔镜小儿肾盂成形术的初步比较[J]. 微创泌尿外科杂志, 2018, 7(1): 6-10.
Liu Dehong, Zhou Huixia, Liu Yujing, Ma Lifei, Cao Hualin, Zhou Xiaoguang, Tao Tian, Hao Xuemei. Comparison of hidden incision endoscopic surgery and traditional port placement for robotic assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(1): 6-10.
[1] Peters CA, Schlussel RN, Retik AB.Pediatric laparoscopic dismembered pyeloplasty. J Urol, 1995,153(6):1962-1965. [2] Mei H, Pu J, Yang C, et al.Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol, 2011,25(5):727-736. [3] 张旭,丁强.机器人技术的沿革与展望.微创泌尿外科杂志,2013,2(4):225-226. [4] Casale P, Kojima Y.Robotic-assisted laparoscopic surgery in pediatric urology: an update. Scand J Surg, 2009,98(2):110-119. [5] Cundy TP, Shetty K, Clark J, et al.The first decade of robotic surgery in children. J Pediatr Surg, 2013,48(4):858-865. [6] Gargollo PC.Hidden incision endoscopic surgery: description of technique, parental satisfaction and applications. J Urol, 2011,185(4):1425-1431. [7] Hong YH, Defoor WJ, Reddy PP, et al. Hidden incision endoscopic surgery (HIdES) trocar placement for pediatric robotic pyeloplasty: comparison to traditional port placement. J Robot Surg, 2017, Mar,14, doi: 10.1007/s11701-017-0684-2, https://link.springer.com/article/10.1007%2Fs11701-017-0684-2. [8] Liu DH, Zhou HX, Ma LF, et al.Comparison of laparoscopic approaches for dismembered pyeloplasty in children with ureteropelvic junction obstruction: critical analysis of 11-year experiences in a single surgeon. Urology, 2017,101(SI):50-55. [9] Daniel Dindo ND, Pierre-Alain Clavien EA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004,240(2):205-213. [10] Palese MA, Munver R, Phillips CK, et al.Robot-assisted laparoscopic dismembered pyeloplasty. JSLS, 2005,9:252-257. [11] Casale P.Robotic pyeloplasty in the pediatric population. Curr Urol Rep, 2009,10(1):55-59. [12] Gettman MT, Peschel R, Neururer R, et al.A comparison of laparoscopic pyeloplasty performed with the daVinci robotic system versus standard laparoscopic techniques: initial clinical results. Eur Urol, 2002,42(5):453-458. [13] Yee DS, Shanberg AM, Duel BP, et al.Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children. Urology, 2006,67(3):599-602. [14] Lee RS, Retik AB, Borer JG, et al.Pediatric robot assisted laparoscopic dismembered pyeloplasty: comparison with a cohort of open surgery. J Urol, 2006,175(2):683-687. [15] Cundy TP, Gattas NE, White AD.Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty. J Pediatr Surg, 2015,50(8):1368-1373. [16] 黄格元,蓝传亮,刘雪来,等.达芬奇机器人在小儿外科手术中的应用(附20例报告).中国微创外科杂志,2013,13(1):4-8. [17] 吕逸清,谢华,黄轶晨,等.机器人辅助腹腔镜下儿童肾盂成形术的初步探讨.中华泌尿外科杂志,2015,36(10):721-725. [18] Braga LH, Pace K, Demaria J, et al.Systematic review and Meta-Analysis of Robotic-Assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate. Eur Urol, 2009,56(5):848-857. [19] Minnillo B, Cruz JA, Sayao RH, et al.Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults. J Urol, 2011,185(4):1455-1460. [20] Luijendijk RW, Jeekel J, Storm RK, et al.The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment. Ann Surg, 1997,225(4):365-369.
