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Strope M, Amin A. Minimally invasive surgery in the operating rooms near you. Curr Opin Anaesthesiol 2025:00001503-990000000-00285. [PMID: 40207572 DOI: 10.1097/aco.0000000000001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
PURPOSE OF REVIEW This review delineates the benefits of minimally invasive surgery (MIS) and its utilization at surgical centers and our institution. It further explores the literature for comparative outcomes of performing MIS to traditional open surgery for a variety of surgical subspecialties. RECENT FINDINGS In addition to its proven safety when compared to the open surgical technique, MIS has broad applications in many surgical subspecialties to enhance perioperative outcomes in both pediatric and adult patients. SUMMARY Although there are certain disadvantages with regard to cost of implementation in nascent communities and total operating time when the surgical complexity increases (such as utilizing a robotic approach), the added benefit of improved patient outcomes due to smaller incision sites is repeatedly proven in the literature making this technique globally essential.
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Affiliation(s)
- Matthew Strope
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Wang H, Xia T, Xiao C, Li H, He X, Qiao Y, Zhong M, Wang D, Li K. An assisted suspension fixation technique in transperitoneal laparoscopic pyeloplasty for infants and young children with ureteropelvic junction obstruction: a retrospective cohort study. Transl Androl Urol 2025; 14:820-830. [PMID: 40226051 PMCID: PMC11986522 DOI: 10.21037/tau-2024-722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 02/27/2025] [Indexed: 04/15/2025] Open
Abstract
Background Anderson-Hynes pyeloplasty is a classic and highly effective technique for treating congenital ureteropelvic junction obstruction (UPJO). Laparoscopic minimally invasive surgery (MIS) has become the preferred approach for infants and young children. However, a small working area and the complexity of reconstruction procedure pose significant challenges. This study aims to evaluate the efficacy and safety of four-point suspension fixation technique in laparoscopic dismembered pyeloplasty (LDP) for infants and young children with UPJO. Methods This retrospective cohort enrolled 37 infants and young children diagnosed with UPJO and underwent transperitoneal LDP between 2014 and 2020. The 37 cases were divided into two Groups based on whether suspension fixation was applied during the transperitoneal LDP. Clinical characteristics and follow-up data of these cohorts were retrospectively collected and analyzed. Continuous variables with a normal distribution were expressed as mean ± standard deviation (SD) and analyzed using independent sample t-tests. Non-normally distributed continuous variables were reported as interquartile range (IQR) and analyzed with the Mann-Whitney U-test. Results In Group A, 21 cases underwent conventional LDP without suspension fixation, while in Group B, 16 cases underwent "suspension fixation" LDP. The operative time (237.9±63.0 vs. 186.4±52.3 min, P=0.01), anastomotic suturing completion time (125.2±21.6 vs. 75.9±12.1 min, P<0.001), and postoperative hospital stay duration [6.0 (4.0, 7.5) vs. 4.5 (3.0, 6.5) days, P=0.04] were significantly shorter in Group B than in Group A, and the intraoperative blood loss [15.0 (5.0, 21.0) vs. 7.5 (5.0, 10.8) mL, P=0.04] in Group B was significantly lower than that in Group A. There were no significant differences between the two Groups in preoperative and anteroposterior renal pelvic diameter (APD), postoperative days to drainage tube removal, and postoperative days to removal of double J (D-J) sent. In Group A, one case developed anastomotic stenosis during follow-up, which improved after ureteral balloon dilation. In Group B, one case developed recurrent febrile urinary tract infection (UTI) within two months of D-J stent removal and was ultimately cured with antibiotic treatment during follow-up. The success rates were 95.2% (20/21) in Group A and 93.8% (15/16) in Group B. Other cases who were followed up showed no recurrence of stenosis, urine leakage, or recurrent UTI. Conclusions The use of assisted suspension fixation in transperitoneal LDP is safe and efficient for infants and young children, helping to reduce operative time, overcome the small laparoscopic operating area, and address the steep learning curve, making it a valuable approach.
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Affiliation(s)
- Hua Wang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tian Xia
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chutian Xiao
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Houhe Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xionglong He
- Department of Urology, Zhaoqing Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Zhaoqing, China
| | - Yuming Qiao
- Department of Urology, Zhaoqing Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Zhaoqing, China
| | - Meinong Zhong
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Urology, Zhaoqing Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Zhaoqing, China
| | - Dejuan Wang
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Urology, Zhaoqing Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Zhaoqing, China
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Kubiak R, Hornok Z, Csukas D, Ferencz A, Cserni T. Feasibility and Challenges of Pyeloureteral Magnetic Anastomosis Device in Domestic Pigs: A Stepwise Approach with Extended Observation. Eur J Pediatr Surg 2025. [PMID: 39832767 DOI: 10.1055/a-2507-8135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
OBJECTIVE The pyeloureteral anastomosis remains the most challenging part of pyeloplasty. A purpose-built anastomotic device could simplify this step and potentially improve outcomes. The concept of a pyeloureteral magnetic anastomosis device (PUMA) was proven in minipigs, but only in short term. Our aim was to test the PUMA in domestic pigs and achieve a prolonged follow-up period. METHODS Five female domestic pigs underwent laparoscopy and ligation of the left ureter. Four weeks later, laparoscopic implantation of the PUMA was planned. Removal of the device and a retrograde contrast study were scheduled after another 4 weeks. The experiment was terminated when the animals could no longer be properly cared for due to their weight. RESULTS Due to unexpected smaller ureteric diameters, a modified PUMA could only be successfully inserted in pig number 3 (49 kg). Four weeks later, the device was found to be dislocated, but the anastomosis remained patent. After modifying the study protocol, the PUMA was successfully implanted in pigs number 4 (96 kg) and 5 (68 kg) 8 weeks after ureteric ligation. Pig 4 developed malignant hyperthermia and died. In pig 5, the magnets were removed 4 weeks later. After an additional 8 weeks, the animal reached 135 kg and was terminated. The anastomosis remained patent and preserved its diameter. CONCLUSION Despite limitations, our study successfully demonstrated that the PUMA can achieve a patent ureteric anastomosis in domestic pigs. This suggests a potential for minimally invasive ureteric anastomosis in clinical settings. Further research is needed to optimize the technique and validate its effectiveness in humans.
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Affiliation(s)
- Rainer Kubiak
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, Sankt Gallen, Switzerland
| | - Zita Hornok
- Department of Pediatric Surgery, Hungarian Reformed Church Bethesda Children's Hospital, Budapest, Hungary
| | - Domokos Csukas
- Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Ferencz
- Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamas Cserni
- Department of Pediatric Urology, Manchester Children's Hospitals, Manchester, United Kingdom of Great Britain and Northern Ireland
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Ali R, Mohsin R, Khan A, Hassan AS, Ali S, Hashmi A, Faizan M. Early post-operative outcomes of robot-assisted pyeloplasty in patients with unilateral ureteropelvic junction obstruction. Int Urol Nephrol 2024; 56:2607-2613. [PMID: 38549000 DOI: 10.1007/s11255-024-04010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is a commonly encountered abnormality and it can lead to serious consequences such as renal dysplasia eventually resulting in loss of kidney. Hence, early diagnosis and timely management remains the cornerstone of the treatment. The most anticipated technique amongst modern day urologist is the robot-assisted laparoscopic pyeloplasty (RALP). The study aims to determine early post-operative outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedure in patients presenting with unilateral ureteropelvic junction obstruction to establish the local perspective. METHODOLOGY This is a descriptive study involving patients with ureteropelvic junction obstruction in a tertiary care facility in Karachi; Sindh Institute of Urology and Transplant (SIUT). A total of 46 participants were recruited. Robot-assisted laparoscopic transperitoneal dismembered Hynes-Anderson pyeloplasty was performed by a single surgeon with over 3 years of experience in the presence of the researcher. Early postoperative outcome total operative time, length of hospital stay, console time and blood loss were noted by the researcher as per operational definition. Data were analyzed on SPSS Version 22. RESULTS Mean age in our study was 46.51 years with the standard deviation of ± 10.87. Whereas, mean length of hospital stay, total operative time, total blood loss, console time, pre-hemoglobin, posthemoglobin, height, weight and BMI in our study was 1.19 ± 0.40 days, 64.58 ± 17.59 min, 9.56 ± 6.13 ml, 30.17 ± 4.99 min, 12.66 ± 1.47 ml, 11.79 ± 1.93 ml, 165.62 ± 8.23 cm, 68.34 ± 8.23 kg and 24.85 ± 3.34 kg/m2, respectively. CONCLUSION Recent advancements in technology have yielded the latest RALP technique which has been proven significantly better than existing approaches and similar results are reported by this study demonstrating improvement in peri-operative and post-operative outcomes ultimately ameliorating the quality of life of patients with UPJO.
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Affiliation(s)
- Rashid Ali
- Sindh Institute of Urology and Transplant (SIUT), Karachi, Pakistan
| | - Rehan Mohsin
- Sindh Institute of Urology and Transplant (SIUT), Karachi, Pakistan
| | - Ayesha Khan
- Sindh Institute of Urology and Transplant (SIUT), Karachi, Pakistan
| | | | - Shoukat Ali
- Sindh Institute of Urology and Transplant (SIUT), Karachi, Pakistan
| | - Altaf Hashmi
- Sindh Institute of Urology and Transplant (SIUT), Karachi, Pakistan
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Chen R, Jiang C, Li X, Yang C, Zhu T, Wang Y. Analysis of risk factors for stenosis after laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Int Urol Nephrol 2024; 56:1911-1918. [PMID: 38244116 PMCID: PMC11090959 DOI: 10.1007/s11255-023-03906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Laparoscopic ureteroplasty is an effective method for managing ureteropelvic junction obstruction. Despite its high success rate, there remains a subset of patients who do not experience improvement in the hydrops. METHODS The study retrospectively analyzed the data of 143 patients with ureteropelvic junction obstruction (UPJO) who underwent laparoscopic pyeloplasty (LP) in our hospital from January 2015 to May 2022. Logistic regression was used to analyze the risk factors of recurrence stenosis after UPJO. RESULTS Out of these patients, 119 had complete clinical data and follow-up records. Among these patients, restenosis occurred in nine cases after the operation. There was a significant statistical difference in blood loss (P < 0.05). Univariate and multivariate logistic regression analysis revealed that the preoperative separation degree of the renal pelvis, cystatin C, and intraoperative blood loss were potential risk factors for recurrent stenosis after primary LP. When divided by split renal function (SRF), the odds ratio (OR) was 7.850 (P = 0.044), indicating that it was an independent risk factor for postoperative restenosis. Similarly, the OR for stenotic segment length was 0.025 (P = 0.011), also indicating it as an independent risk factor for restenosis. The areas under the receiver operating characteristic curve for stenotic segment length and SRF were 0.9056 and 0.7697, respectively. CONCLUSION In our study, we identified that preoperative renal pelvis separation, cystatin C, and intraoperative blood loss were potential risk factors for postoperative restenosis. SRF and stenosis segment length were independent risk factors for postoperative restenosis.
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Affiliation(s)
- Ruilong Chen
- Department of Urology, Anhui Medical University Second Hospital, Hefei Economic and Technological Development Zone, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Chao Jiang
- Department of Urology, Anhui Medical University Second Hospital, Hefei Economic and Technological Development Zone, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Xiang Li
- Department of Urology, Anhui Medical University Second Hospital, Hefei Economic and Technological Development Zone, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Chao Yang
- Department of Urology, Anhui Medical University Second Hospital, Hefei Economic and Technological Development Zone, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Tengfei Zhu
- Department of Urology, Anhui Medical University Second Hospital, Hefei Economic and Technological Development Zone, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Yi Wang
- Department of Urology, Anhui Medical University Second Hospital, Hefei Economic and Technological Development Zone, No. 678 Furong Road, Hefei, 230601, Anhui, China.
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Kallidonis P, Tatanis V, Peteinaris A, Katsakiori P, Gkeka K, Faitatziadis S, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system. World J Urol 2023; 41:3155-3160. [PMID: 37668715 DOI: 10.1007/s00345-023-04586-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE This pilot study was designed to interpret the technically specific features of the avatera robotic system and present our initial experience with this novel platform in robot-assisted pyeloplasty (RAP). METHODS A single-center prospective study was conducted including all patients who underwent RAP with the avatera robotic system from June 2022 to October 2022 in our Department. Transperitoneal robot-assisted dismembered pyeloplasty was performed in all cases. The trocar placement and the surgical technique were similar in all patients. The successful completion of the procedures, operation time (including draping, docking and console time), decrease in hemoglobin postoperatively, and presence of any complications were the study's primary endpoints. RESULTS In total, nine patients underwent RAP using the avatera system. All procedures were successfully completed. The draping of the robotic unit was completed in a median time of 10 min (range 7-15), while the median docking time was 17 min (range 10-24). The median console time was 88 min (range 78-116) and no complications were noticed. The median hemoglobin drop was calculated to 0.7 g/dL (range 0.4-1). During the mean follow-up of 9.33 ± 2.78 months, no late postoperative complications were noticed. CONCLUSION The early outcomes of the use of the novel avatera system in RAP are presented. All operations were successfully completed with safety and efficacy, without complications or significant blood loss.
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Affiliation(s)
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.
- Department of Urology, Medical University of Vienna, Vienna, Austria.
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
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