Robotic versus Open Pyeloplasty: Perioperative and Functional Outcomes

Moretto, Stefano; Gandi, Carlo; Bientinesi, Riccardo; Totaro, Angelo; Marino, Filippo; Gavi, Filippo; Russo, A.; Aceto, Paola; Pierconti, Francesco; Bassi, Pierfrancesco; Sacco, Emilio

doi:10.3390/jcm12072538

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…Fourth, robotic surgery has better ergonomics that helps alleviate the fatigue of surgeons during surgery. Fifth, performing the refined operation in a limited space reduces secondary injuries ( 6 , 14 – 17 ). Finally, the learning curve of robot surgery is short, and is significantly shorter in surgeons with considerable LP experience.…”

Section: Discussionmentioning

confidence: 99%

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children

Li,

Chen,

Jia

et al. 2024

Front. Pediatr.

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ObjectiveTo compare the efficacy of robot-assisted single-port-plus-one pyeloplasty (RSPY) and laparoscopic single-port pyeloplasty (LSPY) in the treatment of children with ureteropelvic junction obstruction (UPJO).MethodsThe clinical data of 47 children who underwent surgery for UPJO at the Department of the Pediatric Surgery of the Fujian Provincial Hospital from October 2020 to September 2022 were analyzed retrospectively. Of these 47 children, 27 received RSPY while 20 underwent LSPY. The baseline data, operation time, intraoperative anastomosis time, intraoperative blood loss, postoperative hospital stay, complications, total cost, preoperative and postoperative renal parenchymal thickness (PT), anteroposterior renal pelvis diameter (APD), and differential renal function (DRF) of the two groups were compared to evaluate the clinical efficacy of the two surgical methods.ResultsThe results showed that both surgical techniques were successful and no patient transitioned to open surgery. There was no significant difference between the two groups in baseline data, intraoperative blood loss, complications, APD, and PT 6 months after surgery. There was also no significant difference in APD, PT, and DRF 12 months after surgery (all P > 0.05). Compared with the LSPY group, the RSPY group had shorter operation time [(153.04 ± 14.44) vs. (189.90 ± 32.59) min, t = −5.24, P < 0.05], less intraoperative anastomosis time [(68.81 ± 16.80) vs. (97.45 ± 11.99) min, t = −6.49, P < 0.05], shorter postoperative hospital stay [(5.96 ± 1.34) vs. (9.00 ± 1.33) d, t = −7.68, P < 0.05], but higher total cost [(57,390 ± 7,664) vs. (30,183 ± 4,219) yuan, t = 14.32, P < 0.05].ConclusionCompared with LSPY, RSPY achieves equivalent efficacy in the treatment of UPJO in children and has certain advantages by shortening the operation time, intraoperative anastomosis time, and postoperative hospital stay. However, its cost burden is heavy, and appropriate cases need to be selected for popularization and application.

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Section: Discussionmentioning

confidence: 99%

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children

Li,

Chen,

Jia

et al. 2024

Front. Pediatr.

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“…Minimally invasive surgery is known to have lower rates of bleeding in standard patients and surgery on the ureter, e.g. neo-implantation or pyeloplasty, is rarely performed with open surgery today (15,29). Robotassisted surgery could offer advantages in kidney transplantation that could reduce complication rates through the minimally invasive nature of the procedure as well as the technical advantages of performing both anastomoses.…”

Section: Discussionmentioning

confidence: 99%

Open-label randomised clinical trial investigating whether Robot-Assisted Kidney Transplantation can reduce surgical complications compared to Open Kidney Transplantation (ORAKTx): Study protocol for a randomised clinical trial

Ortved,

Dagnæs-Hansen,

Stroomberg

et al. 2024

Preprint

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Background: Kidney transplantation is the ultimate treatment for end-stage kidney disease. Function of the kidney graft is not only dependent on medical factors but also a complication-free surgical procedure. In the event of major surgical complications, the kidney graft is potentially lost and the patient will return to the waiting list which may be long. To optimise peri-operative care and reduce complications, robot-assisted kidney transplantation (RAKT) has been introduced as an alternative to open kidney transplantation (OKT), but to our knowledge no randomised clinical trials are comparing RAKT to OKT. We will explore whether robot-assisted surgery can reduce 30-day surgical complications compared to open surgery in kidney transplantation. Methods: This a single-site, open-label, randomised clinical trial comparing RAKT to OKT. Participants are adult recipients of kidney transplantation and all participants are recruited from Copenhagen University Hospital – Rigshospitalet, Denmark. The study plans to include 106 participants who will be randomised in a 1:1 manner between OKT and RAKT. Primary outcomes are vascular- and major surgical complications at 30 days post-operatively. Participants will be followed for two years to evaluate secondary outcomes including recovery, late complications and kidney graft function. This is designed as a superiority trial and planned analyses are as intention-to-treat. Discussion: Studies indicate RAKT can reduce several surgical complications, but the lack of RCTs limits the extrapolation of these results to justify the replacement of an open approach with a robot-assisted one. Ultimately, the introduction of new surgical techniques should be as vigorously tested as any other new treatments. However, reducing surgical complications that compromise graft viability could lead to improved patient care and survival. Trial registration: The trial was prospectively registered on February 15th 2023 on clinicaltrials.gov with NCT-identifier 05730257.

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“…A wide range of surgical treatments have made extensive use of minimally invasive surgical techniques. Using minimally invasive methods more frequently is one way to reduce surgical morbidity and accelerate recovery [6]. To reduce surgical morbidity, minimally invasive procedures, like robotic-assisted radical cystectomy (RARC), have been developed.…”

Section: Introductionmentioning

confidence: 99%

Assessing Trifecta and Pentafecta Success Rates between Robot-Assisted vs. Open Radical Cystectomy: A Propensity Score-Matched Analysis

Gavi,

Foschi,

Fettucciari

et al. 2024

Cancers

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Background: This study aimed to evaluate the surgical and oncological outcomes of robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) using trifecta and pentafecta parameters. Methods: The clinical data of 41 patients who underwent RARC between 2018 and 2022 were prospectively collected and retrospectively compared to those of 330 patients undergoing ORC using 1:1 propensity score matching. Trifecta was defined as simultaneous negative surgical margins (SMs), a lymph node (LN) yield ≥ 16, and the absence of major complications (Clavien–Dindo grade III–V) within 90 days postoperatively. Pentafecta additionally included a 12-month recurrence-free rate and a time between the transurethral resection of a bladder tumor (TURBT) and radical cystectomy (RC) ≤ 3 months. The continuous variables were compared using the Mann–Whitney U test, and the categorical variables were analyzed using the chi-squared test. Results: No statistically significant differences in trifecta and pentafecta success rates were observed between the RARC and ORC cohorts after propensity score matching. However, the RARC group exhibited significantly reduced blood loss (RARC: 317 mL vs. ORC: 525 mL, p = 0.01). Conclusions: RARC offers distinct advantages over ORC in terms of reduced blood loss, while trifecta and pentafecta success rates do not differ significantly between the two surgical approaches.

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Robotic versus Open Pyeloplasty: Perioperative and Functional Outcomes

Cited by 8 publications

References 29 publications

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children

Open-label randomised clinical trial investigating whether Robot-Assisted Kidney Transplantation can reduce surgical complications compared to Open Kidney Transplantation (ORAKTx): Study protocol for a randomised clinical trial

Assessing Trifecta and Pentafecta Success Rates between Robot-Assisted vs. Open Radical Cystectomy: A Propensity Score-Matched Analysis

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