| Objective :To compare the safety,feasibility,efficacy and efficacy of robot-assisted laparoscopy and pediatric laparoscopic Anderson-Hynes in the treatment of congenital UPJHN in children.Method:A total of 102 children aged 16 and under who were diagnosed as UPJHN and underwent Anderson-Hynes surgery in the Department of Urology of the second affiliated Hospital of Kunming Medical University from September 2018 to December 2022 were collected(the fourth generation of Leonardo da Vinci robotic surgery system was introduced in our hospital on September 8,2020,pediatric laparoscopic surgery was selected until September 2020,and robot-assisted surgery was mainly selected from then on to December 2022).General data(sex,age,height,weight,BMI,diseased side),operation related indexes(total hospitalization time,postoperative hospital stay,total operation time,intraoperative pyeloureterostomy time,intraoperative bleeding volume)were collected.Preoperative APD,thickness of thinnest renal cortex,ratio of anterior and posterior diameter of renal pelvis to thinnest renal cortex,widest ureter above obstruction and diuretic radionuclide imaging calculated DRF)and postoperative follow-up indexes(postoperative APD,thinnest thickness of renal cortex,ratio of anterior and posterior diameter of renal pelvis to thinnest renal cortex,widest ureter above obstruction and DRF calculated by diuretic radionuclide imaging).Double J tubes were removed under ureteroscope in all children 4-12 weeks after operation.Excluding the lack of relevant data and children who did not meet the inclusion criteria,a total of 63 children were included in the study.21 children who received robot-assisted laparoscopic pyeloplasty were selected as RALP group,and 42 children who underwent laparoscopic pyeloplasty were taken as LP group.According to UTD grading system,RALP group and LP group were further divided into mild,moderate and severe subgroups.Finally,the general data,perioperative indexes and postoperative follow-up indexes of RALP group,LP group and each subgroup were compared.Results:In this study,63 children with UPJHN were included in this study,and all the operations were successfully completed without conversion to open surgery.Among the 21 cases in the RALP group,1 case was high access to the ureter,2 cases were ectopic vascular compression,and the remaining 18 cases were dynamic obstruction;in the LP group,1 case was UPJ polyp,1 case was retrocaval ureter,2cases were ectopic vascular compression,and the remaining 38 cases were dynamic obstruction.Compared with the general data of the two groups,the age,height and weight of children in the RALP group were significantly smaller than those in the LP group,and the difference was statistically significant.63 cases were followed up for 2 to 34 months,with a median follow-up time of16 months.B-ultrasound,CTU or MRU showed that the postoperative APD of 21 cases in RALP group was significantly lower than that before operation [(1.37±0.73)cm vs.(3.09±1.18)cm,t=7.209,P=0.000],and the thinnest part of renal cortex after operation was significantly increased compared with that before operation [0.66(0.45,69)cm vs.0.32(0.21,0.36)cm,t=-4.043,P=0.000],after operation,the ratio of the anteroposterior diameter of the renal pelvis to the thinnest part of the affected renal cortex decreased significantly compared with that before operation[(2.56±1.75)vs.(11.57±6.41),t=6.811,P=0.000],the widest part of the ureter above the affected side obstruction decreased significantly after operation [(0.75±0.24)cm vs.(1.40±0.61)cm,t=5.352,P=0.000],the DRF of diseased kidney after operation was significantly higher than that before operation [(60.67±8.63)ml/min vs.(55.79±14.36)ml/min,t=-2.511,P=0.021];APD of 42 cases in LP group decreased significantly after operation as compared with that before operation[1.89(1.25,2.90)cm vs.(3.22±1.31)cm,t=3.487,P=0.000],and the thinnest part of renal cortex increased significantly after operation[0.66(0.45,0.77)cm vs.0.60(0.31,0.72)cm,t=-3.356,P=0.001],the ratio of the anteroposterior diameter of the renal pelvis to the thinnest part of the affected renal cortex decreased significantly after operation compared with that before operation[(3.48±1.80)vs.5.95(3.51,12.31),t=2.672,P=0.008],and the widest part of the ureter above the obstruction of the affected side decreased significantly after operation [0.80(0.66,1.22)cm vs.(1.69±0.82)cm,t=3.302,P=0.001].The thinnest point of renal cortex in RALP group was significantly smaller than that in LP group [0.32(0.21,0.36)cm vs.0.60(0.31,0.72)cm,t=-2.089,P=0.037],The total operation time in RALP group was slightly longer than that in LP group[(4.21±0.65)h vs.3.50(3.50,4.50)h,t=-1.979,P=0.048],and the intraoperative blood loss in RALP group was less than that in LP group[(9.62±5.45)ml vs.20(10,20)ml,t=-3.085,P=0.002],the postoperative DRF in RALP group was significantly lower than that in LP group[(1.37±0.73)cm vs.1.89(1.25,2.90)cm,t=-2.779,P=0.005],the postoperative renal DRF in RALP group was significantly larger than that in LP group [(60.67±8.63)ml/min vs.52.05(48.30,55.56)ml/min,t=-3.169,P=0.002].In RALP group,there was a large amount of anastomotic exudation caused by improper position of double J tube 2 days after operation,which was cured after adjustment of double J tube under ureteroscope.In LP group,1 case developed flatulence 6 days after operation,which was relieved after enema,and 1case with urinary tract infection and hydronephrosis worsened 4 days after operation,which was relieved after symptomatic treatment.There was no significant difference in postoperative complications between the two groups.Conclusion:1.Robot-assisted laparoscopy is as safe,feasible and effective as pediatric laparoscopic Anderson-Hynes in children with UPJHN.2.The APD value and renal DFR value of robot-assisted laparoscopic Anderson-Hynes and pediatric laparoscopic Anderson-Hynes were significantly improved compared with those before operation.3.Robotic-assisted laparoscopy and pediatric laparoscopic Anderson-Hynes had a positive correlation between the degree of hydronephrosis and some surgical parameters in the treatment of UPJHN children,but the performance parameters were different,and the robotic-assisted laparoscopic group was manifested in the time of surgery,APD on the affected side before and after surgery,the ratio of anteroposterior diameter of the renal pelvis to the thinnest part of the renal cortex on the affected side before and after surgery,and the widest ureter above the postoperative obstruction of the affected side.The pediatric laparoscopic group showed the ratio of intraoperative blood loss,APD on the affected side before surgery,anteroposterior diameter of the renal pelvis on the affected side before surgery to the thinnest part of the renal cortex.4.The robot-assisted laparoscopy group was significantly superior to the pediatric laparoscopic group in reducing intraoperative bleeding,reducing postoperative APD and improving postoperative DFR. |
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