Comparison of Robotic Vascular Hitch to Traditional Dismembered Pyeloplasty
Anna Marie Mears, BS1, Merry Peckham, MD1, Jedidiah Whitt, BS1, Ashay Patel, DO2, Ismael Zamilpa, MD2, Stephen Canon, MD2.
1University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2Arkansas Children's Hospital, Little Rock, AR, USA.
Intro: Although dismembered pyeloplasty (DP) has been the traditional technique utilized with robotic surgery for ureteropelvic junction obstruction (UPJO), the vascular hitch (VH) technique has also recently been implemented for correction of this congenital renal obstruction. The VH procedure does not require ureteral stent placement and prevents the need for excision of the UPJO. The aim of this study is to compare these robotic-assisted approaches for DP and VH.
Methods: All patients with a history of robotic-assisted laparoscopic procedure with either dismembered pyeloplasty (DP) or vascular hitch procedure (VH) for UPJO were reviewed. Patients with UPJO without crossing vessels and those with recurrent UPJOs were excluded. Variables collected included demographics, length of surgery (LOS (include retrograde pyelogram)), length of hospital stay (HS), pre- and post-operative imaging studies with ultrasound hydronephrosis grades, success rates, complications, and length of follow-up (FU).
Results: Sixty-nine patients (17 VH and 52 DP) were retrospectively evaluated. No difference in mean age nor gender between the two cohorts was identified. There was no difference in the utilization of renograms and renal ultrasound (RUS) pre-operatively. Additionally, mean pre-operative hydronephrosis grades were comparable. Mean LOS in minutes was significantly shorter in VH patients compared to DP, 168 and 216, respectively (p=0.0002). All patients in the DP group underwent a follow up cystoscopy with ureteral stent removal under anesthesia. Both groups had equivalent HS and utilization of post-operative renogram and RUS studies. The improvement in pre-operative and post-operative hydronephrosis grading were similar between the two groups as well (p=0.0862). Successful UPJO correction was comparable as well: VH 93% and DP 94% (p=0.9701). Only minor complications were found in both groups: 17.7% VH group and 15.4% DP (p=0.825). Mean length of FU (months) was 16.4 and 20.6 for VH and DP, respectively (p=0.338).
Conclusion: Robotic-assisted laparoscopic vascular hitch appears to be comparable in efficacy to robotic-assisted dismembered pyeloplasty. In addition to avoiding the need for a follow up anesthetic procedure for ureteral stent removal, completion of the robotic-assisted laparoscopic vascular hitch was performed in less time than that of robotic dismembered pyeloplasty. Additional larger, prospective studies would be beneficial to better understand the potential benefits of the vascular hitch procedure for correction of ureteropelvic junction obstruction due to crossing vessels.
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