Defining the Pros and Cons of Open, Conventional Laparoscopy, and Robot-Assisted Pyeloplasty in a Developing Nation

Abstract

Introduction. Congenital pelviureteric junction obstruction (PUJO) is one of the most common causes of hydronephrosis. Historically, open dismembered pyeloplasty has been considered the gold standard intervention for correcting PUJO. The aim of this study was to compare the surgical and functional outcomes of three different approaches, namely, open, conventional laparoscopy, and robotic pyeloplasty. Material and Methods. 60 patients underwent minimally invasive pyeloplasty (30 conventional laparoscopies and 30 robotics) for congenital PUJO at a tertiary health center in India. Demographic, perioperative, and postoperative data were prospectively collected and analyzed. The data of these patients were retrospectively compared with another cohort of 30 patients who had undergone open pyeloplasty. Results. There was significant difference in operative time, time to drain removal, hospital stay, pain score, and complications rate between open and minimally invasive pyeloplasty (P < 0.05). SFI was considerably lesser in robotic as compared to conventional laparoscopy. The success rate in OP, CLP, and RP was 93.33, 96.67, and 96.67%. Conclusion. Robotic pyeloplasty is safe, effective, and feasible. It is associated with significantly lesser operative time, lesser blood loss, less pain, shorter hospital stay, and fewer complications. It is also associated with considerably lesser surgeon fatigue as compared to conventional laparoscopy pyeloplasty.

Peri‐operative outcomes and complications after laparoscopic vs robot‐assisted dismembered pyeloplasty: a systematic review and meta‐analysis

“…All 17 were observational studies . Thirteen studies had a retrospective design [], three were prospective , and one used both retrospective and prospective data collection . Two studies reported patient matching .…”

“…Our search strategies identified 4101 articles, with 17 full-text studies meeting our eligibility criteria to be included in the present review ( Fig. 1) [3,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The authors of one study, on request for further data, provided eligible primary patient data collected prospectively since their original publication [20].…”

“…All 17 were observational studies [2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Thirteen studies had a retrospective design [3,[11][12][13][14][15][16][17][18][22][23][24][25], three were prospective [10,19,20], and one used both retrospective and prospective data collection [21]. Two studies reported patient matching [3,21].…”

Development of stereo endoscope system with its innovative master interface for continuous surgical operation

“…The tests were performed for 10 times. The results indicate that the iNMI is able to operate for 317 min (SD: 12 min), which is much longer than the average time for several types of robotic surgeries [1, 4, 28, 29]. However, the iNMI can also be used for surgeries which exceed its time duration since the battery can be simply changed to a new one which would cause minimum inconvenience.…”

Transperitoneal laparoscopic pyeloplasty in children and adolescents

“…In this study, double-J stent was inserted in all cases antegradely during the operation. Two steps may have a role in diminishing the mean operative time in this study: the first step was the fixation of redundant renal pelvis to anterior abdominal wall using vicryl 2/0 as a sling, which acts as retraction, and sparing one trocar; and the second step was the insertion of double-J stent over the guidewire passed through puncture needle after spatulation of the ureter [20][21][22].…”