- 作者：Riccardo Autorino ; Christopher Eden ; Alaa El-Ghoneimi ; Giorgio Guazzoni ; Nicol貌maria Buffi ; Craig A. Peters ; Robert J. Stein ; Matthew Gettman
- 关键词：Laparoscopy ; Robot-assisted ; Pyeloplasty ; Ureteropelvic junction obstruction
- 刊名：European Urology
- 出版年：February, 2014
- 年：2014
- 卷：65
- 期：2
- 页码：430-452
- 全文大小：4700 K
Context
Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized.Objective
To critically analyze the current status of laparoscopic and robotic repair of UPJO.
Evidence acquisition
A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria.
Evidence synthesis
Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population.
Conclusions
Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.