Searching for the Least Invasive Management of Pelvi-Ureteric Junction Obstruction in Children: A Critical Literature Review of Comparative Outcomes

Frontiers in Pediatrics

article

Marco Castagnetti¹  Massimo Iafrate¹  Ciro Esposito²  Ramnath Subramaniam³ 

[1] Section of Paediatric Urology, Department of Surgical, and Gastrointestinal Sciences, University Hospital of Padova;Department of Paediatrics, Federico II University of Naples;Department of Paediatric Urology, Leeds Teaching Hospitals NHS Trust, University of Leeds, United Kingdom;Department of Paediatric Urology, University of Ghent

关键词: pyeloplasty;    pelvi-ureteric junction;    obstructive uropathy;    hydronephrosis;    minimally-invasive surgery;    robotic surgery;   

DOI  :  10.3389/fped.2020.00252

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction: To review the published evidence on the minimally invasive pyeloplasty techniques available currently with particular emphasis on the comparative data about the various minimally invasive alternatives to treat pelvi-ureteric junction obstruction and gauge if one should be favored under certain circumstances. Materials and Methods: Non-systematic review of literature on open and minimally invasive pyeloplasty including various kinds of laparoscopic procedures, the robotic-assisted laparoscopic pyeloplasty, and endourological procedures. Results: Any particular minimally invasive pyeloplasty procedure seems feasible in experienced hands, irrespective of age including infants. Comparative data suggest that the robotic-assisted procedure has gained wider acceptance mainly because it is ergonomically more suited to surgeon well-being and facilitates advanced skills with dexterity thanks to 7 degrees of freedom. However, costs remain the major drawback of robotic surgery. In young children and infants, instead, open surgery can be performed via a relatively small incision and quicker time frame. Conclusions: The best approach for pyeloplasty is still a matter of debate. The robotic approach has gained increasing acceptance over the last years with major advantages of the surgeon well-being and ergonomics and the ease of suturing. Evidence, however, may favor the use of open surgery in infancy.

【 授权许可】

CC BY