Advertisement

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

  • Ciro AndolfiEmail author
  • Brittany Adamic
  • Jerry Oommen
  • Mohan S. Gundeti
Topic Paper
  • 12 Downloads

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.

Keywords

Pediatric urology Ureteropelvic junction obstruction Robot-assisted laparoscopic pyeloplasty Robotic pyeloplasty Laparoscopic pyeloplasty 

Notes

Author contributions

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.

Compliance with ethical standards

Conflict of interest

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

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Does not apply.

References

  1. 1.
    Anderson JC, Hynes W (1949) Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol 21(3):209–214CrossRefGoogle Scholar
  2. 2.
    Liu DB, Ellimoottil C, Flum AS, Casey JT, Gong EM (2014) Contemporary national comparison of open, laparoscopic, and robotic-assisted laparoscopic pediatric pyeloplasty. J Pediatr Urol 10(4):610–615.  https://doi.org/10.1016/j.jpurol.2014.06.010 CrossRefGoogle Scholar
  3. 3.
    Martin JA, Hamilton BE, Osterman MJ (2015) Births in the United States, 2014. NCHS Data Brief 216:1–8Google Scholar
  4. 4.
    Varda BK, Wang Y, Chung BI, Lee RS, Kurtz MP, Nelson CP et al (2018) Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015. J Pediatr Urol 14(4):336.  https://doi.org/10.1016/j.jpurol.2017.12.010 CrossRefGoogle Scholar
  5. 5.
    Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q (2011) Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol 25(5):727–736.  https://doi.org/10.1089/end.2010.0544 (e1–e8) CrossRefGoogle Scholar
  6. 6.
    Huang Y, Wu Y, Shan W, Zeng L, Huang L (2015) An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children. Int J Clin Exp Med 8(4):4922–4931Google Scholar
  7. 7.
    Cascio S, Tien A, Chee W, Tan HL (2007) Laparoscopic dismembered pyeloplasty in children younger than 2 years. J Urol 177(1):335–338.  https://doi.org/10.1016/j.juro.2006.08.145 CrossRefGoogle Scholar
  8. 8.
    Tan HL (1999) Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol 162(3 Pt 2):1045–1047 (discussion 8) CrossRefGoogle Scholar
  9. 9.
    Tan HL (2001) Laparoscopic Anderson-Hynes dismembered pyeloplasty in children using needlescopic instrumentation. Urol Clin N Am 28(1):43–51 (viii) CrossRefGoogle Scholar
  10. 10.
    Tan HL, Roberts JP (1996) Laparoscopic dismembered pyeloplasty in children: preliminary results. Br J Urol 77(6):909–913CrossRefGoogle Scholar
  11. 11.
    Sukumar S, Roghmann F, Sood A, Abdo A, Menon M, Sammon JD et al (2014) Correction of ureteropelvic junction obstruction in children: national trends and comparative effectiveness in operative outcomes. J Endourol 28(5):592–598.  https://doi.org/10.1089/end.2013.0618 CrossRefGoogle Scholar
  12. 12.
    Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM (1993) Laparoscopic dismembered pyeloplasty. J Urol 150(6):1795–1799CrossRefGoogle Scholar
  13. 13.
    Valla JS, Breaud J, Griffin SJ, Sautot-Vial N, Beretta F, Guana R et al (2009) Retroperitoneoscopic vs open dismembered pyeloplasty for ureteropelvic junction obstruction in children. J Pediatr Urol 5(5):368–373.  https://doi.org/10.1016/j.jpurol.2009.02.202 CrossRefGoogle Scholar
  14. 14.
    Yeung CK, Tam YH, Sihoe JD, Lee KH, Liu KW (2001) Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children. BJU Int 87(6):509–513CrossRefGoogle Scholar
  15. 15.
    Peters CA (2004) Robotically assisted surgery in pediatric urology. Urol Clin N Am 31(4):743–752.  https://doi.org/10.1016/j.ucl.2004.06.007 CrossRefGoogle Scholar
  16. 16.
    Murphy D, Challacombe B, Olsburgh J, Calder F, Mamode N, Khan MS et al (2008) Ablative and reconstructive robotic-assisted laparoscopic renal surgery. Int J Clin Pract 62(11):1703–1708.  https://doi.org/10.1111/j.1742-1241.2007.01563.x CrossRefGoogle Scholar
  17. 17.
    Monn MF, Bahler CD, Schneider EB, Whittam BM, Misseri R, Rink RC et al (2013) Trends in robot-assisted laparoscopic pyeloplasty in pediatric patients. Urology 81(6):1336–1341.  https://doi.org/10.1016/j.urology.2013.01.025 CrossRefGoogle Scholar
  18. 18.
    Cundy TP, Harling L, Hughes-Hallett A, Mayer EK, Najmaldin AS, Athanasiou T et al (2014) Meta-analysis of robot-assisted vs conventional laparoscopic and open pyeloplasty in children. BJU Int 114(4):582–594CrossRefGoogle Scholar
  19. 19.
    Franco I, Dyer LL, Zelkovic P (2007) Laparoscopic pyeloplasty in the pediatric patient: hand sewn anastomosis versus robotic assisted anastomosis—is there a difference? J Urol 178(4 Pt 1):1483–1486.  https://doi.org/10.1016/j.juro.2007.06.012 CrossRefGoogle Scholar
  20. 20.
    Ganpule A, Jairath A, Singh A, Mishra S, Sabnis R, Desai M (2015) Robotic versus conventional laparoscopic pyeloplasty in children less than 20 kg by weight: single-center experience. World J Urol 33(11):1867–1873.  https://doi.org/10.1007/s00345-015-1694-1 CrossRefGoogle Scholar
  21. 21.
    Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP (2017) Laparoscopic vs open pyeloplasty in children: results of a randomized, prospective, controlled trial. J Urol 197(3 Pt 1):792–797.  https://doi.org/10.1016/j.juro.2016.10.056 CrossRefGoogle Scholar
  22. 22.
    Lee RS, Retik AB, Borer JG, Peters CA (2006) Pediatric robot assisted laparoscopic dismembered pyeloplasty: comparison with a cohort of open surgery. J Urol 175(2):683–687.  https://doi.org/10.1016/S0022-5347(05)00183-7 (discussion 7) CrossRefGoogle Scholar
  23. 23.
    Patel A, Pickhardt MW, Littlejohn N, Zamilpa I, Rettiganti M, Luo C et al (2016) Shortened operative time for pediatric robotic versus laparoscopic dismembered pyeloplasty. Can J Urol 23(3):8308–8311Google Scholar
  24. 24.
    Riachy E, Cost NG, Defoor WR, Reddy PP, Minevich EA, Noh PH (2013) Pediatric standard and robot-assisted laparoscopic pyeloplasty: a comparative single institution study. J Urol 189(1):283–287.  https://doi.org/10.1016/j.juro.2012.09.008 CrossRefGoogle Scholar
  25. 25.
    Kim S, Canter D, Leone N, Patel R, Casale P (2008) A comparative study between laparoscopic and robotically assisted pyeloplasty in the pediatric population. J Urol 179:357CrossRefGoogle Scholar
  26. 26.
    Silay MS, Spinoit AF, Undre S, Fiala V, Tandogdu Z, Garmanova T et al (2016) Global minimally invasive pyeloplasty study in children: results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party. J Pediatr Urol 12(4):229.  https://doi.org/10.1016/j.jpurol.2016.04.007 (e1–7) CrossRefGoogle Scholar
  27. 27.
    Song SH, Lee C, Jung J, Kim SJ, Park S, Park H et al (2017) A comparative study of pediatric open pyeloplasty, laparoscopy-assisted extracorporeal pyeloplasty, and robot-assisted laparoscopic pyeloplasty. PLoS O ne 12(4):e0175026.  https://doi.org/10.1371/journal.pone.0175026 CrossRefGoogle Scholar
  28. 28.
    Subotic U, Rohard I, Weber DM, Gobet R, Moehrlen U, Gonzalez R (2012) A minimal invasive surgical approach for children of all ages with ureteropelvic junction obstruction. J Pediatr Urol 8(4):354–358.  https://doi.org/10.1016/j.jpurol.2011.07.004 CrossRefGoogle Scholar
  29. 29.
    Ansari MS, Mandhani A, Singh P, Srivastava A, Kumar A, Kapoor R (2008) Laparoscopic pyeloplasty in children: long-term outcome. Int J Urol 15(10):881–884.  https://doi.org/10.1111/j.1442-2042.2008.02139.x CrossRefGoogle Scholar
  30. 30.
    Maheshwari R, Ansari MS, Mandhani A, Srivastava A, Kapoor R (2010) Laparoscopic pyeloplasty in pediatric patients: the SGPGI experience. Indian J Urol 26(1):36–40.  https://doi.org/10.4103/0970-1591.60441 CrossRefGoogle Scholar
  31. 31.
    Psooy K, Pike JG, Leonard MP (2003) Long-term followup of pediatric dismembered pyeloplasty: how long is long enough? J Urol 169(5):1809–1812.  https://doi.org/10.1097/01.ju.0000055040.19568.ea (discussion 12; author reply 12) CrossRefGoogle Scholar
  32. 32.
    Salo M, Sjoberg Altemani T, Anderberg M (2016) Pyeloplasty in children: perioperative results and long-term outcomes of robotic-assisted laparoscopic surgery compared to open surgery. Pediatr Surg Int 32(6):599–607.  https://doi.org/10.1007/s00383-016-3869-2 CrossRefGoogle Scholar
  33. 33.
    Neheman A, Kord E, Zisman A, Darawsha AE, Noh PH (2018) Comparison of robotic pyeloplasty and standard laparoscopic pyeloplasty in infants: a bi-institutional study. J Laparoendosc Adv Surg Tech A 28(4):467–470.  https://doi.org/10.1089/lap.2017.0262 CrossRefGoogle Scholar
  34. 34.
    Avery DI, Herbst KW, Lendvay TS, Noh PH, Dangle P, Gundeti MS et al (2015) Robot-assisted laparoscopic pyeloplasty: multi-institutional experience in infants. J Pediatr Urol 11(3):139.  https://doi.org/10.1016/j.jpurol.2014.11.025 (e1–5) CrossRefGoogle Scholar
  35. 35.
    Bansal D, Cost NG, DeFoor WR Jr, Reddy PP, Minevich EA, Vanderbrink BA et al (2014) Infant robotic pyeloplasty: comparison with an open cohort. J Pediatr Urol 10(2):380–385.  https://doi.org/10.1016/j.jpurol.2013.10.016 CrossRefGoogle Scholar
  36. 36.
    Kutikov A, Resnick M, Casale P (2006) Laparoscopic pyeloplasty in the infant younger than 6 months—is it technically possible? J Urol 175(4):1477–1479.  https://doi.org/10.1016/S0022-5347(05)00673-7 (discussion 9) CrossRefGoogle Scholar
  37. 37.
    Turner RM 2nd, Fox JA, Tomaszewski JJ, Schneck FX, Docimo SG, Ost MC (2013) Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants. J Urol 189(4):1503–1507.  https://doi.org/10.1016/j.juro.2012.10.067 CrossRefGoogle Scholar
  38. 38.
    Braga LH, Lorenzo AJ, Skeldon S, Dave S, Bagli DJ, Khoury AE et al (2007) Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol 178(6):2571–2575.  https://doi.org/10.1016/j.juro.2007.08.050 (discussion 5) CrossRefGoogle Scholar
  39. 39.
    Ahn JJ, Shapiro ME, Ellison JS, Lendvay TS (2017) Pediatric robot-assisted redo pyeloplasty with buccal mucosa graft: a novel technique. Urology 101:56–59.  https://doi.org/10.1016/j.urology.2016.12.036 CrossRefGoogle Scholar
  40. 40.
    Alhazmi HH (2018) Redo laparoscopic pyeloplasty among children: a systematic review and meta-analysis. Urol Ann 10(4):347–353.  https://doi.org/10.4103/UA.UA_100_18 CrossRefGoogle Scholar
  41. 41.
    Casella DP, Fox JA, Schneck FX, Cannon GM, Ost MC (2013) Cost analysis of pediatric robot-assisted and laparoscopic pyeloplasty. J Urol 189(3):1083–1086.  https://doi.org/10.1016/j.juro.2012.08.259 CrossRefGoogle Scholar
  42. 42.
    Light A, Karthikeyan S, Maruthan S, Elhage O, Danuser H, Dasgupta P (2018) Peri-operative outcomes and complications after laparoscopic vs robot-assisted dismembered pyeloplasty: a systematic review and meta-analysis. BJU Int 122(2):181–194.  https://doi.org/10.1111/bju.14170 CrossRefGoogle Scholar
  43. 43.
    Lee LC, Kanaroglou N, Gleason JM, Pippi Salle JL, Bagli DJ, Koyle MA et al (2015) Impact of drainage technique on pediatric pyeloplasty: comparative analysis of externalized uretero-pyelostomy versus double-J internal stents. Can Urol Assoc J 9(7–8):E453–E457.  https://doi.org/10.5489/cuaj.2697 CrossRefGoogle Scholar
  44. 44.
    Rodriguez AR, Rich MA, Swana HS (2012) Stentless pediatric robotic pyeloplasty. Ther Adv Urol 4(2):57–60.  https://doi.org/10.1177/1756287211434927 CrossRefGoogle Scholar
  45. 45.
    Silva MV, Levy AC, Finkelstein JB, Van Batavia JP, Casale P (2015) Is peri-operative urethral catheter drainage enough? The case for stentless pediatric robotic pyeloplasty. J Pediatr Urol 11(4):175.  https://doi.org/10.1016/j.jpurol.2015.06.003 (e1–5) CrossRefGoogle Scholar
  46. 46.
    Yiee JH, Baskin LS (2011) Use of internal stent, external transanastomotic stent or no stent during pediatric pyeloplasty: a decision tree cost-effectiveness analysis. J Urol 185(2):673–680.  https://doi.org/10.1016/j.juro.2010.09.118 CrossRefGoogle Scholar
  47. 47.
    Ferroni MC, Lyon TD, Rycyna KJ, Dwyer ME, Schneck FX, Ost MC et al (2016) The role of prophylactic antibiotics after minimally invasive pyeloplasty with ureteral stent placement in children. Urology 89:107–111.  https://doi.org/10.1016/j.urology.2015.11.035 CrossRefGoogle Scholar
  48. 48.
    Bennett WE Jr, Whittam BM, Szymanski KM, Rink RC, Cain MP, Carroll AE (2017) Validated cost comparison of open vs. robotic pyeloplasty in American children's hospitals. J Robot Surg 11(2):201–206.  https://doi.org/10.1007/s11701-016-0645-1 CrossRefGoogle Scholar
  49. 49.
    Andolfi C, Umanskiy K (2017) Mastering robotic surgery: where does the learning curve lead us? J Laparoendosc Adv Surg Tech A 27(5):470–474.  https://doi.org/10.1089/lap.2016.0641 CrossRefGoogle Scholar
  50. 50.
    Chan YY, Durbin-Johnson B, Sturm RM, Kurzrock EA (2017) Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions. J Pediatr Urol 13(1):49.  https://doi.org/10.1016/j.jpurol.2016.08.029 (e1–e6) CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric Urology, Section of Urology, Department of Surgery, Comer Children’s HospitalThe University of Chicago Pritzker School of MedicineChicagoUSA
  2. 2.Michigan State University College of Osteopathic MedicineEast LansingUSA
  3. 3.Section of Adult and Pediatric Urology, Department of Surgery, MacLean Center for Clinical Medical Ethics, Center for SimulationThe University of Chicago Medicine, Comer Children’s HospitalChicagoUSA

Personalised recommendations