Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study
Ninety-day perioperative complications of pediatric robotic urological surgery: A multi-institutional study
复制标题
DOI：
10.1016/j.jpurol.2015.08.015
复制
发表时间：
2016-04-01
影响因子：
2
通讯作者：
Gundeti, M. S.
中科院分区：
文献类型：
--
作者：
Dangle, P. P.;Akhavan, A.;Gundeti, M. S.
背景机器人技术是医疗设备中最新的微创手术工具。各个中心已经报道了与这项技术相关的结果和并发症，但这些研究的数量仍然很少，很难推断有意义的信息。目的是通过多中心数据库评估大量的儿科机器人患者，以确定在美国与机器人手术相关的并发症的频率和类型。研究设计在参与中心的机构审查委员会批准后，每个机构回顾收集数据(2007-2011年)，并输入RedCap(R)数据库。结果在858例患者中，41例(4.8%)出现IIIa级和IIIb级并发症，1例(0.1%)出现IVa级并发症。术中继发内脏损伤的患者有4例(0.5%)，继发于机器人器械更换和牵引损伤，随后转为开放手术。I级并发症59例(6.9%)，II级并发症70例(8.2%)，均为保守治疗。共有14例(1.6%)中转开腹或纯腹腔镜手术，其中12例(86%)继发于机械挑战。880例患者发生ClavienⅢa级和Ⅲb级并发症的发生率为4.7%。虽然数字很小，很难对最复杂的重建病例(膀胱憩室切除、膀胱颈翻修等)得出结论，但关于更常见的手术，如肾盂成形术和输尿管再植，数据是可靠的，更有可能代表这些手术的真实并发症发生率，当这些手术由经验丰富的机器人外科医生进行时。并发症：N(%)危及生命(IVA)：1(0.1%)需要放射和/或手术干预(IIIa和IIIb)：41(4.8%)继发于机器人系统：4(0.5%)机械故障导致中转：14(1.6%)
BackgroundRobotic technology is the newest tool in the armamentarium for minimally invasive surgery. Individual centers have reported on both the outcomes and complications associated with this technology, but the numbers in these studies remain small, and it has been difficult to extrapolate meaningful information.ObjectivesThe intention was to evaluate a large cohort of pediatric robotic patients through a multi-center database in order to determine the frequency and types of complications associated with robotic surgery for pediatric reconstructive and ablative procedures in the United States.Study designAfter institutional review board approvals at the participating centers, data were retrospectively collected (2007-2011) by each institute and entered into a RedCap (R) database. Available demographic and complication data that were assigned Clavien grading scores were analyzed.ResultsFrom a cohort of 858 patients (880 RAL procedures), Grade IIIa and Grade IIIb complications were seen in 41 (4.8%); and one patient (0.1%) had a grade IVa complication. Intraoperative visceral injuries secondary to robotic instrument exchange and traction injury were seen in four (0.5%) patients, with subsequent conversion to an open procedure. Grade I and II complications were seen in 59 (6.9%) and 70 (8.2%) patients, respectively; they were all managed conservatively. A total of 14 (1.6%) were converted to an open or pure laparoscopic procedure, of which, 12 (86%) were secondary to mechanical challenges.DiscussionIt is believed that this study represents the largest and most comprehensive description of pediatric RAL urological complications to date. The results demonstrate a 4.7% rate of Clavien Grade IIIa and Grade IIIb complications in a total of 880 cases. While small numbers make it difficult to draw conclusions regarding the most complex reconstructive cases (bladder diverticulectomy, bladder neck revision, etc.), the data on the more commonly performed procedures, such as the RAL pyeloplasty and ureteral reimplantation, are robust and more likely represent the true complication rate for these procedures when performed by highly experienced robotic surgeons.ConclusionPediatric robotic urologic procedures are technically feasible and safe. The overall 90-day complication rate is similar to reports of laparoscopic and open surgical procedures.Complications: n (%)Life threatening (IVa): 1 (0.1%)Requiring radiologic and or surgical intervention (IIIa and IIIb): 41 (4.8%)Secondary to robotic system: 4 (0.5%)Mechanical failure leading to conversion: 14 (1.6%)