What’s the best minimal invasive approach to pediatric nephrectomy and heminephrectomy: conventional laparoscopy (CL), single-site (LESS) or robotics (RAS)?

Till, Holger; Basharkhah, Ali; Hock, A

doi:10.21037/tp.2016.09.01

Cited by 17 publications

(8 citation statements)

References 17 publications

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“…Direct comparisons have been published for paediatric robot-assisted pyeloplasty and showed no difference [41] . A systematic review on paediatric RN and PN found no differences regarding complications, success rates or short-term outcomes between the robotic and the conventional laparoscopic approach, but higher costs and longer operative time in the robotic group [42] . Regarding paediatric robot-assisted laparoscopic pyeloplasty the differences between the robotic operation and conventional laparoscopy in most series to date were only a shorter length of stay for the robotic approach [43] .…”

Section: Resultsmentioning

confidence: 99%

The age of robotic surgery – Is laparoscopy dead?

Schwaibold

Wiesend

Bach

2018

Arab Journal of Urology

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IntroductionRobot-assisted laparoscopic surgery (RALS) has become a widely used technology in urology. Urological procedures that are now being routinely performed robotically are: radical prostatectomy (RP), radical cystectomy (RC), renal procedures – mainly partial nephrectomy (PN), and pyeloplasty, as well as ureteric re-implantation and adrenalectomy.MethodsThis non-systematic review of the literature examines the effectiveness of RALS compared with conventional laparoscopic surgery for the most relevant urological procedures.ResultsFor robot-assisted RP there seems to be an advantage in terms of continence and potency over laparoscopy. Robot-assisted RC seems equal in terms of oncological outcome but with lower complication rates; however, the effect of intracorporeal urinary diversion has hardly been examined. Robotic PN has proven safe and is most likely superior to conventional laparoscopy, whereas there does not seem to be a real advantage for the robot in radical nephrectomy. For reconstructive procedures, e.g. pyeloplasty and ureteric re-implantation, there seems to be advantages in terms of operating time.ConclusionsWe found substantial, albeit mostly low-quality evidence, that robotic operations can have better outcomes than procedures performed laparoscopically. However, in light of the significant costs and because high-quality data from prospective randomised trials are still missing, conventional urological laparoscopy is certainly not ‘dead’ yet.

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Section: Resultsmentioning

confidence: 99%

The age of robotic surgery – Is laparoscopy dead?

Schwaibold

Wiesend

Bach

2018

Arab Journal of Urology

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“…Till et al [23] recently published a review of literature on minimal invasive approaches to pediatric nephrectomy and hemine-phrectomy and found that conventional laparoscopy represents the method of choice for any age group compared to robot-assisted surgery and LESS surgery. However, they recommended further larger studies to investigate the cosmetic benefits of LESS surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoendoscopic Single-Site (LESS) Surgery in Pediatric Urology: A 4-Year Experience

Zouari¹,

Dhaou²,

Ammar³

et al. 2019

Current Urology

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Objective: The aim of the study was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single-site (LESS) surgery. Materials and Methods: We retrospectively collected charts of all patients who underwent LESS procedures in our department from January 2013 to December 2016. Data included demographic characteristics, type of procedures, intraoperative details, hospital stay, and complications. The umbilicus was used as the surgical site in all cases. All procedures were performed with a homemade glove port and standard straight 3- or 5-mm laparoscopic instruments. Results: Seventy-three patients (55 males, 18 females) were identifed. Procedures included 46 orchidop-exies, 21 pyeloplasties, 8 varicocelectomies, 3 nephrecto-mies, 3 nephroureterectomies, 3 orchiectomies, and 1 renal hydatid cyst treatment. Median operative time for the entire cohort was 47 min (range 26-156 min). There was no signifcant intraoperative blood loss. No conversion to conventional laparoscopy or open surgery was needed. All patients required paracetamol postoperatively. The mean follow-up was 18 months. Two patients had testicular atrophy after a Fowler-Stephens procedure and 1 patient had testicular reascension. Cosmetic results were excellent. Forty-five (62.5%) patients were discharged on the day of surgery. Conclusion: Our study demonstrated that LESS surgery using our glove port technique and conventional laparoscopic instruments is a feasible and safe technique for the surgical management of various pediatric urological conditions.

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“…A lower conversion rate to radical nephrectomy, renal function using indexed estimated glomerular filtration rate, a shorter length of hospital stay, and a shorter warm ischemia time, all were improved with robotic procedures. In 2015 Till et al, also published a metaanalysis examining eleven paediatric studies that reported on the differences between conventional laparoscopy compared to laparoscopic single site and robotic surgery, in relation to partial and total nephrectomy [18]. The paediatric data did not offer any clear advantages over conventional laparoscopy and the operative time and cost was significantly increased.…”

Section: Nephrectomy and Hemi-nephrectomymentioning

confidence: 99%

Paediatric robotic surgery and urology: where are we?

Clarke

2019

J Ped Endosc Surg

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What’s the best minimal invasive approach to pediatric nephrectomy and heminephrectomy: conventional laparoscopy (CL), single-site (LESS) or robotics (RAS)?

Cited by 17 publications

References 17 publications

The age of robotic surgery – Is laparoscopy dead?

The age of robotic surgery – Is laparoscopy dead?

Laparoendoscopic Single-Site (LESS) Surgery in Pediatric Urology: A 4-Year Experience

Paediatric robotic surgery and urology: where are we?

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