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Minerva Urologica e Nefrologica 2020 Aug 04

DOI: 10.23736/S0393-2249.20.03854-0


lingua: Inglese

Robot-assisted laparoscopic pyeloplasty in children: a systematic review

Lorenzo MASIERI 1, 2 , Simone SFORZA 1, 2, Antonio A. GROSSO 2, Francesca VALASTRO 2, Riccardo TELLINI 2, Chiara CINI 1, Luca LANDI 1, Maria TAVERNA 1, Antonio ELIA 1, Alberto MANTOVANI 1, Andrea MINERVINI 2, Marco CARINI 2

1 Department of Pediatric Urology, University of Florence, Meyer Hospital, Florence, Italy; 2 Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy


INTRODUCTION: Open pyeloplasty has been the first-line treatment for uretero-pelvic junction obstruction for decades. In the last years, minimally-invasive surgery (MIS) has gained popularity in the pediatric’s field. Furthermore, recently, a great extension of Robot-assisted laparoscopic pyeloplasty (RALP) has been seen in younger and lighter-weight children as well as in redo cases. Herein we provided a comprehensive review of primary and redo RALP performed in children, particularly focusing on the different distribution of outcomes among the ages.
EVIDENCE ACQUISITION: A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical indication and technique, intraoperative nuances, peri- and postoperative outcomes of primary and redo RALP.
EVIDENCE SYNTHESIS: Overall, 33 studies with 1448 patients were included for primary RALP and 7 studies with 101 patients for redo cases between 2000 and 2019. In particular, 4 studies aimed to compare RALP in different cohorts of children grouped on ages or weight and 4 studies evaluated technical feasibility and safety of RALP over laparoscopic and open approach in very young populations. Success rate for primary RALP was found >90% in all studies but one, with low complication rate and reoperative indication. In redo series, 96% of patients revealed a decreased hydronephrosis on postoperative imaging.
CONCLUSIONS: RALP offers excellent outcomes in the pediatric population. However, there is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials. The rising of new robotic systems, such as single-port platform, might further enhance the applications of RALP in children.

KEY WORDS: Minimally invasive surgery; Robotic; Infant; UPJO; Malformation; Ureteropelvic junction obstruction; Paediatric; Redo pyeloplasty; Redo surgery; Urinary anomaly

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