Abstract
Purpose We performed a systematic review and meta-analysis to compare the safety and efficacy
of minimally invasive surgery (MIS) versus open ureteral reimplantation (OUR) in children.
Methods Literature searches were conducted to identify studies that compared MIS (laparoscopic
ureteral reimplantation or robot-assisted laparoscopic ureteral replantation) and
OUR in children. Parameters such as operative time, blood loss, length of hospital
stay, success rate, postoperative urinary tract infection (UTI), urinary retention,
postoperative hematuria, wound infection, and overall postoperative complications
were pooled and compared by meta-analysis.
Results Among the 7,882 pediatric participants in the 14 studies, 852 received MIS, and 7,030
received OUR. When compared with the OUR, the MIS approach resulted in shorter hospital
stays (I
2 = 99%, weighted mean difference [WMD] –2.82, 95% confidence interval [CI] –4.22 to
–1.41; p < 0.001), less blood loss (I
2 = 100%, WMD –12.65, 95% CI –24.82 to –0.48; p = 0.04), and less wound infection (I
2 = 0%, odds ratio 0.23, 95% CI 0.06–0.78; p = 0.02). However, no significant difference was found in operative time and secondary
outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and
overall postoperative complications.
Conclusion MIS is a safe, feasible, and effective surgical procedure in children when compared
with OUR. Compared with OUR, MIS has a shorter hospital stay, less blood loss, and
less wound infection. Furthermore, MIS is equivalent to OUR in terms of success rate
and secondary outcomes such as postoperative UTI, urinary retention, postoperative
hematuria, and overall postoperative complications. We conclude that MIS should be
considered an acceptable option for pediatric ureteral reimplantation.
Keywords
laparoscopic surgery - robot-assisted laparoscopic surgery - open surgery - ureteral
reimplantation - children - meta-analysis
