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World Journal of Urology

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01-08-2020 | Pyeloplasty | Topic Paper

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

Authors: Ciro Andolfi, Brittany Adamic, Jerry Oommen, Mohan S. Gundeti

Published in: World Journal of Urology | Issue 8/2020

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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Title: Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy?
Authors: Ciro Andolfi
Brittany Adamic
Jerry Oommen
Mohan S. Gundeti
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pyeloplasty
Laparoscopy
Ureteropelvic Junction Obstruction
Pyeloplasty
Pediatric Urology
Pediatric Urology
Minimally Invasive Surgery
Published in: World Journal of Urology / Issue 8/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02943-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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