Abstract
Background: This study aims to conduct a comparative analysis of the safety, feasibility, and efficacy of robot-assisted laparoscopy and pediatric laparoscopic Anderson-Hynes surgery in the treatment of congenital ureteropelvic junction type hydronephrosis (UPJHN) in children.
Method: A retrospective comparison of pediatric laparoscopic (n = 42) versus robotic-assisted laparoscopy (n = 21) Anderson-Hynes procedure at the Department of Urology in the Second Affiliated Hospital of Kunming Medical University from September 2018 to December 2022. Based on the urinary tract dilation (UTD) grading system, we segmented the Robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) groups into three subgroups: mild, moderate, and severe. In our final analysis, we compared the RALP and LP groups, along with their respective subgroups, regarding their general patient data, surgical indicators, and postoperative follow-up markers to evaluate the efficacy of the treatments.
Results and limitations:
The study enrolled 63 children diagnosed with UPJHN, where 21 were grouped under RALP, and 42 were under the LP unit. The median follow-up duration was 16 months. When comparing postoperative and preoperative parameters in the RALP group, the postoperative anteroposterior pelvis diameter (APD) (P = 0.000), as well as the ratio of the APD to the thinnest part of the affected renal cortex (P = 0.000), decreased considerably, as did the widest part of the ureter above the obstruction (P = 0.000). However, the postoperative renal cortex at the thinnest point and differential renal function (DRF) of the affected kidney increased significantly (P = 0.021). For the LP group, significant reductions were noted in postoperative APD (P = 0.000), the widest part of the ureter above the obstruction (P = 0.001), and the ratio of APD to the thinnest part of the affected renal cortex (P = 0.008). However, the thinnest part of the renal cortex showed substantial post-surgery enlargement (P = 0.001). Contrasting the parameters between RALP and LP groups, the RALP group had a significantly tinier preoperative measure of the thinnest part of the renal cortex (P = 0.037), extended operation duration (P = 0.048), and less intraoperative bleeding (P = 0.002). Also, their postoperative APD (P = 0.005) was remarkably smaller with a notably higher postoperative DRF (P = 0.002) of affected kidneys. Evaluating postoperative complications did not yield any statistical significance in either group.
Conclusion: After undergoing robot-assisted laparoscopy and the pediatric laparoscopic Anderson-Hynes procedure, children with UPJHN showed a substantial improvement in both APD and DRF of the compromised kidneys. Of particular note, the RALP group noticeably surpassed the pediatric laparoscopic surgery cohort in curtailing intraoperative bleeding, diminishing postoperative APD values, and enhancing postoperative DRF of the affected kidney. As a result, RALP proves itself to be just as safe, manageable, and efficient as the pediatric laparoscopic Anderson-Hynes procedure in the treatment strategy for children grappling with UPJHN.