Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: A systematic review and meta-analysis

Riccardo Autorino, Christopher Eden, Alaa El-Ghoneimi, Giorgio Guazzoni, Nicolòmaria Buffi, Craig A Peters, Robert J. Stein, Matthew Gettman

Research output: Contribution to journalReview article

89 Citations (Scopus)

Abstract

Context Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. Objective To critically analyze the current status of laparoscopic and robotic repair of UPJO. Evidence acquisition A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Evidence synthesis Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.

Original languageEnglish (US)
Pages (from-to)430-452
Number of pages23
JournalEuropean Urology
Volume65
Issue number2
DOIs
StatePublished - Feb 1 2014

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Robotics
Meta-Analysis
Pediatrics
Laparoscopy
Population
Learning Curve
Standard of Care
PubMed
Length of Stay
Technology
Morbidity

Keywords

  • Laparoscopy
  • Pyeloplasty
  • Robot-assisted
  • Ureteropelvic junction obstruction

ASJC Scopus subject areas

  • Urology

Cite this

Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction : A systematic review and meta-analysis. / Autorino, Riccardo; Eden, Christopher; El-Ghoneimi, Alaa; Guazzoni, Giorgio; Buffi, Nicolòmaria; Peters, Craig A; Stein, Robert J.; Gettman, Matthew.

In: European Urology, Vol. 65, No. 2, 01.02.2014, p. 430-452.

Research output: Contribution to journalReview article

Autorino, R, Eden, C, El-Ghoneimi, A, Guazzoni, G, Buffi, N, Peters, CA, Stein, RJ & Gettman, M 2014, 'Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: A systematic review and meta-analysis', European Urology, vol. 65, no. 2, pp. 430-452. https://doi.org/10.1016/j.eururo.2013.06.053
Autorino, Riccardo ; Eden, Christopher ; El-Ghoneimi, Alaa ; Guazzoni, Giorgio ; Buffi, Nicolòmaria ; Peters, Craig A ; Stein, Robert J. ; Gettman, Matthew. / Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction : A systematic review and meta-analysis. In: European Urology. 2014 ; Vol. 65, No. 2. pp. 430-452.
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abstract = "Context Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. Objective To critically analyze the current status of laparoscopic and robotic repair of UPJO. Evidence acquisition A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Evidence synthesis Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.",
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T2 - A systematic review and meta-analysis

AU - Autorino, Riccardo

AU - Eden, Christopher

AU - El-Ghoneimi, Alaa

AU - Guazzoni, Giorgio

AU - Buffi, Nicolòmaria

AU - Peters, Craig A

AU - Stein, Robert J.

AU - Gettman, Matthew

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N2 - Context Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. Objective To critically analyze the current status of laparoscopic and robotic repair of UPJO. Evidence acquisition A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Evidence synthesis Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.

AB - Context Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. Objective To critically analyze the current status of laparoscopic and robotic repair of UPJO. Evidence acquisition A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Evidence synthesis Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.

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