Background

Since its first description, multiple reports proved efficacy and safety of the robotic platform. Further progress has been made allowing for the application of robotic surgery to smaller patients, including infants. Despite the early favorable results, the use of robot surgery in infants is still controversial and more studies are needed to confirm its benefits.

Objective

To our knowledge, we present the largest single-institution case series of robot-assisted laparoscopic pyeloplasty (RAL-P) in infants, aiming to contribute to the current literature with a guide for key technical steps and safety tips for infant RAL-P.

Design, setting, and participants

We performed a retrospective review of a prospectively maintained database. The study protocol was approved by the institutional review board.

Surgical procedure

Only infants (≤12 mo of age) with a diagnosis of congenital ureteropelvic junction obstruction (UPJO) undergoing primary robotic dismembered pyeloplasty were included in the study.

Measurements

We critically reviewed the clinical outcomes, described the main steps of the operation, and shared tips for a safe approach.

Results and limitations

From January 2012 to August 2019, 44 infants underwent RAL-P for UPJO––33 (75%) males and 11 (25%) females. All robotic cases were completed successfully, with no laparotomic conversions. The median age and weight were 4 (1–12) mo and 6.8 (3.8–10.5) kg, respectively. The mean operative time was 142 (±25) min. The mean estimated blood loss was 7 (±3.6) ml, and no intraoperative complications occurred. The mean length of hospital stay (LOS) was 1.4 (±0.7) d. Seven (15.6%) patients had postoperative complications—one (2%) ileus (Clavien-Dindo grade [CDG] I), four (9%) urinary tract infections (CDG II), and two (4.5%) port-site hernias (CDG III). At a median follow-up of 19 mo, the success rate was 100%.

Conclusions

Given the successful outcomes, benefits of decreased LOS, and improved cosmesis, RAL-P is an appealing management option for UPJO in infants. Market release of new systems, further miniaturization of instruments, and more affordable costs will hopefully be shedding light on more complex applications.

Patient summary

Infants (≤12 mo of age) diagnosed with ureteropelvic junction obstruction undergoing primary robotic dismembered pyeloplasty were selected and included in this study. No intraoperative complications or conversion to an open approach occurred. Seven patients (16%) developed postoperative complications—one (2%) postoperative ileus, four (9%) urinary tract infections, and two (4.5%) port-site hernias. At a median follow-up of 19 (7–66) mo, the success rate was 100%.

中文翻译：

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婴儿机器人辅助腹腔镜肾盂成形术：单一机构的结果，以及安全和成功的提示

背景

自首次描述以来，多份报告证明了机器人平台的有效性和安全性。已经取得了进一步的进展，允许将机器人手术应用于包括婴儿在内的较小患者。尽管早期取得了有利的结果，但在婴儿中使用机器人手术仍然存在争议，需要更多的研究来证实其益处。

客观的

据我们所知，我们展示了最大的单机构婴儿机器人辅助腹腔镜肾盂成形术 (RAL-P) 病例系列，旨在为当前的文献提供有关婴儿 RAL-P 关键技术步骤和安全提示的指南。

设计、设置和参与者

我们对前瞻性维护的数据库进行了回顾性审查。研究方案得到了机构审查委员会的批准。

外科手术

该研究仅包括诊断为先天性输尿管盆腔交界处阻塞 (UPJO) 并接受初次机器人肢解肾盂成形术的婴儿（≤12 个月）。

测量

我们严格审查了临床结果，描述了手术的主要步骤，并分享了安全方法的提示。

结果和局限性

从 2012 年 1 月到 2019 年 8 月，44 名婴儿接受了 RAL-P，UPJO--33 名（75%）男性和 11 名（25%）女性。所有机器人病例均成功完成，没有进行剖腹手术。中位年龄和体重分别为 4（1-12）个月和 6.8（3.8-10.5）公斤。平均手术时间为 142 (±25) 分钟。平均估计失血量为 7 (±3.6) ml，未发生术中并发症。平均住院时间 (LOS) 为 1.4 (±0.7) d。七名 (15.6%) 患者出现术后并发症——一名 (2%) 肠梗阻（Clavien-Dindo 分级 [CDG] I）、四名 (9%) 尿路感染 (CDG II) 和两名 (4.5%) 端口部位疝（CDG III）。中位随访 19 个月，成功率为 100%。

结论

鉴于成功的结果、降低 LOS 的益处和改善的美容效果，RAL-P 是婴儿 UPJO 的一种有吸引力的管理选择。新系统的市场发布、仪器的进一步小型化以及更实惠的成本有望为更复杂的应用提供启示。

患者总结

选择诊断为输尿管盆腔交界处梗阻并接受初次机器人肢解肾盂成形术的婴儿（≤12 个月）纳入本研究。没有发生术中并发症或转为开放式方法。7 名患者 (16%) 出现术后并发症——1 名 (2%) 术后肠梗阻，4 名 (9%) 尿路感染和 2 名 (4.5%) 端口疝。在 19 (7-66) 个月的中位随访中，成功率为 100%。