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Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy?

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Abstract

Introduction

Open pyeloplasty (OP) has been the first-line treatment for ureteropelvic junction obstruction (UPJO) since it was first described by Anderson and Hynes. The use of minimally invasive surgery (MIS) to treat UPJO in the pediatric population has increased in recent years, due to decreased morbidity and shorter recovery times. Recently, robot-assisted laparoscopic pyeloplasty (RALP) has seen a steady expansion. Unlike laparoscopic pyeloplasty (LP), RALP comes with a more manageable learning curve aided by specialized technological advantages such as high-resolution three-dimensional view, tremor filtration with motion scaling, and highly dexterous wrist-like instruments. With this review, we aim to highlight the trend toward robotic pyeloplasty over laparoscopy and current available evidence on outcomes.

Methods

We systematically searched the PubMed and EMBASE databases, and we critically reviewed the available literature on the use of laparoscopy and robotic technology in pediatric patients with UPJO.

Results

Overall, we selected 19 original articles and 5 meta-analyses. The available literature showed that the robotic approach to the UPJO allowed for decreased operative times, shorter length of hospital stay, lower complication rates, with success rates comparable to LP. Conflicting results persist regarding robotic platform and equipment costs.

Conclusion

While laparoscopy requires advanced skills for complex reconstructive procedures, such as pyeloplasty, robot-assisted surgery offers the valuable potential of making MIS more accessible to these types of procedure. Robotic technology has contributed to shortening the learning curve by acting as a bridge between open and endoscopic approach. There is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials, as well as further cost-effectiveness analyses. As robotic surgical technology spreads, future systems will be developed, offering smaller and more flexible tools, allowing enhanced applications on pediatric patients.

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Authors and Affiliations

  1. Pediatric Urology, Section of Urology, Department of Surgery, Comer Children’s Hospital, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Ciro Andolfi, Brittany Adamic & Mohan S. Gundeti

  2. Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA

    Jerry Oommen

  3. Section of Adult and Pediatric Urology, Department of Surgery, MacLean Center for Clinical Medical Ethics, Center for Simulation, The University of Chicago Medicine, Comer Children’s Hospital, 5841S. Maryland Ave, Rm J-664, Chicago, IL, 60637, USA

    Ciro Andolfi

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  1. Ciro Andolfi
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  2. Brittany Adamic
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CA: project development, management, manuscript writing/editing. BA: manuscript writing/editing. JO: manuscript writing/editing. MSG: project development, management, manuscript writing/editing. All authors agree to all aspects of the work.

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Correspondence to Ciro Andolfi.

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Dr. Mohan S. Gundeti is co-director for the NARUS course. The other authors have no conflicts of interest to declare.

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Andolfi, C., Adamic, B., Oommen, J. et al. Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy?. World J Urol 38, 1827–1833 (2020). https://doi.org/10.1007/s00345-019-02943-z

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