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首页> 外文期刊>Journal of endourology >Robot-assisted pyeloplasty: follow-up of first Canadian experience with comparison of outcomes between experienced and trainee surgeons.
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Robot-assisted pyeloplasty: follow-up of first Canadian experience with comparison of outcomes between experienced and trainee surgeons.

机译：机器人辅助的肾盂成形术：加拿大首次经验的随访，比较经验丰富的医生和实习医生的结果。

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BACKGROUND AND PURPOSE: Robot-assisted pyeloplasty (RAP) has been established recently as an option in the management of ureteropelvic junction obstruction (UPJO). We present the first Canadian experience with RAP with respect to operative results and outcomes. We compare the surgical outcomes between experienced and trainee surgeons, with respect to operating room times and success rates. PATIENTS AND METHODS: Eighty-eight patients underwent transperitoneal RAP for UPJO using the da Vinci robotic platform. Two surgeons performed Anderson-Hynes dismembered pyeloplasty in 85 cases and YV-plasty in 5 cases. Five patients had RAP for secondary UPJO after failure of other treatments. Diuretic renography was performed at 6 weeks, and 6, 12, 18, 24, and 36 months postpyeloplasty. The mean follow-up was 14.1 +/- 8.5 months. RESULTS: The mean operative time was 167.7 +/- 43.2 minutes, and the mean anastomotic time was 41.9 +/- 14.1 minutes. The mean operative duration significantly decreased with time (P < 0.05). Ten patients needed simultaneous nephroscopic stone management via the pyelotomy incision. The mean blood loss was 56.6 +/- 55.4 mL, and the mean hospital stay was 2.5 +/- 0.5 days. There were five major postoperative (stent migration, urinoma) and three minor complications that were associated with the RAP procedures. Postoperative renal scintigraphy demonstrated only four cases with persistent obstruction. Eighty-three (94.3%) patients experienced improvement of symptoms whereas 5 continued to be symptomatic. Two patients needed secondary procedures to relieve persisting obstruction. There were no statistical differences in outcomes between the experienced surgeons and trainees (P = 0.28). CONCLUSIONS: In the first large case series of RAP from Canada, we demonstrate that RAP can be performed with relatively short operative times and is safe and effective, achieving similar long-term results with standard open repair. We show that robot-assisted surgery can be safely transitioned to surgical trainees. With its cost and availability, its role in the Canadian system needs further study.
机译：背景与目的：机器人辅助肾盂成形术（RAP）最近已被确定为输尿管盆腔连接梗阻（UPJO）的治疗选择。我们介绍了加拿大人在RAP手术方面的首次经验。我们就手术室时间和成功率比较经验丰富的和实习医生之间的手术结果。患者和方法：使用da Vinci机器人平台对88例患者行经腹膜RAP进行UPJO。两名外科医生行Anderson-Hynes肢体切除术85例，YV成形术5例。五例患者在其他治疗失败后接受了RAP进行继发性UPJO。利尿肾造影在肾盂成形术后第6周，第6、12、18、24和36个月进行。平均随访时间为14.1 +/- 8.5个月。结果：平均手术时间为167.7 +/- 43.2分钟，平均吻合时间为41.9 +/- 14.1分钟。平均手术持续时间随时间显着减少（P <0.05）。十名患者需要通过肾切开术切口同时进行肾镜检查。平均失血量为56.6 +/- 55.4 mL，平均住院时间为2.5 +/- 0.5天。与RAP手术相关的五个主要术后（支架迁移，尿路瘤）和三个较小并发症。术后肾脏闪烁显像仅显示4例持续性梗阻。八十三（94.3％）位患者的症状有所改善，而五位患者仍保持症状。两名患者需要二次手术以缓解持续的阻塞。有经验的外科医生和受训者之间的结局无统计学差异（P = 0.28）。结论：在加拿大的RAP的第一个大案例系列中，我们证明了RAP可以在相对较短的手术时间内进行，并且安全有效，在标准开放式修复的情况下可以达到类似的长期效果。我们证明，机器人辅助手术可以安全地过渡到外科手术学员。由于其成本和可用性，其在加拿大系统中的作用需要进一步研究。

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