REVIEW   Free access

Minerva Urologica e Nefrologica 2020 December;72(6):673-90

DOI: 10.23736/S0393-2249.20.03854-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

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, Meyer Hospital, University of Florence, 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 pediatrics 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 preoperative 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 surgical procedures; Robotic surgical procedures; Infant; Pediatrics; Congenital abnormalities