Chen Jingyi,He Shaohua,Xu Di,et al.Comparison of clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation versus laparoscopic ureteral reimplantation for primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,,22():930-936.[doi:10.3760/cma.j.cn101785-202304072-006]
Comparison of clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation versus laparoscopic ureteral reimplantation for primary vesicoureteral reflux in children
- Keywords:
- Vesico-Ureteral Reflux; Surgical Procedures; Operative; Robotic Surgical Procedures; Hand-Assisted Laparoscopy; Replantation; Ureter; Treatment Outcome
- Abstract:
- Objective To compare the clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation (RALUR) versus laparoscopic ureteral reimplantation (LUR) for primary vesicoureteral reflux (VUR) in children.Methods From January 2017 to April 2022,the relevant clinical data were retrospectively reviewed for 70 VUR children.According to surgical approaches,they were assigned into two groups of robot (n=30) and laparoscopy (n=40).Two groups were compared in terms of preoperative preparation time,abdominal operative duration,intraoperative hemorrhage,hospitalization time,surgical success rate and postoperative complications.Results All procedures were successful without any conversion into open surgery.In robot group,reflux was unilateral (n=22) and bilateral (n=8).In laparoscopic group,reflux was unilateral (n=30) and bilateral (n=10).Operative duration: unilateral robotic group min was greater than unilateral laparoscopic group [(155.18±18.94) vs.(126.33±19.75) min].The difference was statistically significant (P<0.05); Bilateral robotic group was greater than bilateral laparoscopic group [(210.50±19.25) vs.(177.10±16.61) min],The difference was statistically significant (P<0.05); Handling duration: unilateral robotic group was longer than unilateral laparoscopic group [(117.77±23.21) vs.(109.30±10.57) min].The difference was statistically insignificant (P=0.180).No significant difference existed between bilateral robotic and bilateral laparoscopic groups [(169.50±25.48) vs.(158.50±16.67) min]; Intraoperative hemorrhage: robotic group was greater than laparoscopic group [(15.20±3.24) vs.(25.23±5.84) ml].The difference was statistically significant (P<0.05); Duration of hospitalization: robotic group was less than laparoscopic group [6.5(6.0,7.0) vs. 7.0(7.0,8.0) day].The difference was statistically significant (P<0.05); Postoperative indwelling time of Foley tube: robotic group was equal to laparoscopic group [3.0(3.0,4.0) vs. 3.0(3.0,4.0) day].The difference was statistically insignificant (P=0.714).One case in robot group and 2 cases in laparoscopic group developed febrile urinary tract infection (UTI) post-operation and recovered after antibiotics treatment.Voiding cystourethrogram (VCUG) revealed unilateral reflux in robot group (n=1) and laparoscopic group (n=3).Four children received continuous antibiotic prophylaxis (CAP) for 3 months and reflux disappeared on VCUG re-examination.One case in robot group and 3 cases in laparoscopic group experienced acute postoperative urinary retention.After time of indwelling catheter was extended to 2 weeks,catheter was successfully removed without further urinary retention.Conclusion Single-port RALUR and LUR are both safe and effective for pediatric VUR.Single-port RALUR has a longer operative duration than LUR and yet less intraoperative hemorrhage and shorter hospitalization stay.Also incision of single-port RALUR is cosmetically superior and RALUR offers some value of clinical application.
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Memo
收稿日期:2023-4-28。
基金项目:福建省卫健委科技计划项目(2021CXO1010125)
通讯作者:何少华,Email:cnfjhsh@163.com