慈濟台北分院 外科部 泌尿科
Comparisons of the efficacy and safety between robotic versus open pediatric pyeloplasty: a systemic review and meta-analysis
Chun-Kai Hsu M.D., Stephen Shei-Dei Yang M.D., Ph.D., Cheng-Hsing Hsieh M.D. and Shang-Jen Chang M.D
Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City
Purpose: To systemically reviewed reported studies that compared the efficacy and safety of robotic (RP) versus open pyeloplasty (OP) in children with ureteropelvic junction obstruction (UPJO)
Materials and Methods: A systemic search of PubMED® was performed to search all randomized controlled trials or comparative studies that compared the surgical results of robotic versus open pyeloplasty in children with ureteropelvic junction obstruction. The two authors (HC Hsu and SJ Chang) independently did literature search, quality assessment, and data extraction. The obtained data were analyzed with Cochrane Collaboration Review Manager (RevMan®, version 5.3). The endpoints of the analysis and review included age, operative time, complications and success rate.
Results: In total, 6 comparative trials and 3 studies using national database met the inclusion criteria which comprised 17420 (RP:OP=1599:15821) patients in our meta-analysis. Most studies reported median value of patient age, operative time and hospital stay. The pooled analysis revealed that RP were more frequently performed in older children, required longer operative time. Most studies reported that RP was associated with less estimated blood loss, less usage of analgesic agents while meta-analysis is not possible due to variability in reporting data. There was a significant higher complication rate in the RP group (RR=1.29, 95 CI 1.10-1.51) while the post-operative success rate was comparable (RR=0.99, 95 CI 0.94-1.04). RP is associated with significant higher costs when compared with RP (WMD, 95CI:).
Conclusions: Robotic assisted pyeloplasty is a promising alternative minimal invasive surgery for UPJO with comparable success rate when compared to gold standard open pyeloplasty. However, the complication rate is higher in the RP group which may be due to surgeons were in their early learning phases and the instrument were not pediatric oriented