Download PDF
Eur J Pediatr Surg
DOI: 10.1055/s-0043-1764321
Original Article

Minimally Invasive versus Open Ureteral Reimplantation in Children: A Systematic Review and Meta-Analysis

Shaoguang Feng‡   *
1   Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
2   Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Zhechen Yu‡   *
2   Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Yicheng Yang‡   *
2   Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Yunli Bi
3   Department of Pediatric Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Jinjian Luo
4   Department of Pulmonary and Critical Care Medicine (PCCM), Anji County People's Hospital, Huzhou, Zhejiang, China
› Author Affiliations Funding This study was supported by Suzhou Key clinical disease diagnosis and treatment technology project (Grant number LCZX201718 to Y.B.).
› Further Information
    Permissions and Reprints

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

Authors' Contributions

S.F. contributed to the conception and design of study and drafting the manuscript. Z.Y. contributed to the acquisition of data and drafting the manuscript. Y.Y. contributed to the acquisition of data, drafting the manuscript. Y.B. contributed to the conception and design of study, analysis and/or interpretation of data. J.L. contributed to the conception and design of study, analysis and/or interpretation of data, and drafting the manuscript.


* These authors contributed equally to the work and retain the first authorship.




Publication History

Received: 30 January 2023

Accepted: 31 January 2023

Article published online:
07 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tullus K. Vesicoureteric reflux in children. Lancet 2015; 385 (9965): 371-379
    CrossrefPubMedGoogle Scholar
  • 2 Celik O, Ipekci T, Aydogdu O, Yucel S. Current medical diagnosis and management of vesicoureteral reflux in children. Nephrourol Mon 2013; 6 (01) e13534
    CrossrefPubMedGoogle Scholar
  • 3 Atala A, Kavoussi LR, Goldstein DS, Retik AB, Peters CA. Laparoscopic correction of vesicoureteral reflux. J Urol 1993; 150 (2 Pt 2): 748-751
    CrossrefPubMedGoogle Scholar
  • 4 Peters CA. Laparoscopic and robotic approach to genitourinary anomalies in children. Urol Clin North Am 2004; 31 (03) 595-605 , xi
    CrossrefPubMedGoogle Scholar
  • 5 Tekgül S, Riedmiller H, Hoebeke P. et al; European Association of Urology. EAU guidelines on vesicoureteral reflux in children. Eur Urol 2012; 62 (03) 534-542
    CrossrefPubMedGoogle Scholar
  • 6 Weiss DA, Shukla AR. The robotic-assisted ureteral reimplantation: the evolution to a new standard. Urol Clin North Am 2015; 42 (01) 99-109
    CrossrefPubMedGoogle Scholar
  • 7 Yeung CK, Chowdhary SK, Sreedhar B. Minimally invasive management for vesicoureteral reflux in infants and young children. Clin Perinatol 2017; 44 (04) 835-849
    CrossrefPubMedGoogle Scholar
  • 8 Kirsch AJ, Arlen AM. Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the ‘Gold Standard’?. Int Braz J Urol 2020; 46 (03) 314-321
    CrossrefPubMedGoogle Scholar
  • 9 Stern N, Wang P, Dave S. Instituting robotic pediatric urologic surgery in the Canadian healthcare system: evaluating the feasibility and outcomes of robot-assisted pyeloplasty and ureteric reimplantation. Can Urol Assoc J 2021; 15 (04) E215-E220
    PubMedGoogle Scholar
  • 10 Fernández-Alcaráz D, Robles-Torres JI, García-Hernández C, Guillén-Lozoya AH, Landa-Juárez S. Laparoscopic vs open extravesical ureteral reimplantation in pediatric population: a single-center experience. Urol J 2022; 19 (06) 427-432
    PubMedGoogle Scholar
  • 11 Arlen AM, Broderick KM, Travers C, Smith EA, Elmore JM, Kirsch AJ. Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population. J Pediatr Urol 2016; 12 (03) 169.e1-169.e6
    CrossrefPubMedGoogle Scholar
  • 12 Bustangi N, Kallas Chemaly A, Scalabre A. et al. Extravesical ureteral reimplantation following Lich-Gregoir technique for the correction of vesico-ureteral reflux retrospective comparative study open vs. laparoscopy. Front Pediatr 2018; 6: 388
    CrossrefPubMedGoogle Scholar
  • 13 Esposito C, Escolino M, Lopez M. et al. Surgical management of pediatric vesicoureteral reflux: a comparative study between endoscopic, laparoscopic, and open surgery. J Laparoendosc Adv Surg Tech A 2016; 26 (07) 574-580
    CrossrefPubMedGoogle Scholar
  • 14 Marchini GS, Hong YK, Minnillo BJ. et al. Robotic assisted laparoscopic ureteral reimplantation in children: case matched comparative study with open surgical approach. J Urol 2011; 185 (05) 1870-1875
    CrossrefPubMedGoogle Scholar
  • 15 Smith RP, Oliver JL, Peters CA. Pediatric robotic extravesical ureteral reimplantation: comparison with open surgery. J Urol 2011; 185 (05) 1876-1881
    CrossrefPubMedGoogle Scholar
  • 16 Tae BS, Jeon BJ, Choi H, Park JY, Bae JH. Comparison of open and pneumovesical approaches for Politano-Leadbetter ureteric reimplantation: a single-center long-term follow-up study. J Pediatr Urol 2019; 15 (05) 513.e1-513.e7
    CrossrefPubMedGoogle Scholar
  • 17 Wang J, Mou Y, Li A. Comparison of open and pneumovesical Cohen approach for treatment of primary vesicoureteral junction obstruction in children. J Laparoendosc Adv Surg Tech A 2020; 30 (03) 328-333
    CrossrefPubMedGoogle Scholar
  • 18 Zhu X, Wang J, Zhu H. et al. Lich-Gregoir vesico-ureteral reimplantation for duplex kidney anomalies in the pediatric population: a retrospective cohort study between laparoscopic and open surgery. Transl Pediatr 2021; 10 (01) 26-32
    CrossrefPubMedGoogle Scholar
  • 19 Schomburg JL, Haberman K, Willihnganz-Lawson KH, Shukla AR. Robot-assisted laparoscopic ureteral reimplantation: a single surgeon comparison to open surgery. J Pediatr Urol 2014; 10 (05) 875-879
    CrossrefPubMedGoogle Scholar
  • 20 Bowen DK, Faasse MA, Liu DB, Gong EM, Lindgren BW, Johnson EK. Use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States: 2000 to 2012. J Urol 2016; 196 (01) 207-212
    CrossrefPubMedGoogle Scholar
  • 21 Elizondo RA, Au JK, Song SH. et al. Open versus robot-assisted laparoscopic ureteral reimplantation: hospital charges analysis and outcomes at a single institution. J Pediatr Surg 2020;S0022-3468(19)30901-7
    PubMedGoogle Scholar
  • 22 Tessier B, Scalabre A, Harper L. et al. Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children. Surg Endosc 2022; DOI: 10.1007/s00464-021-08985-y.
    CrossrefPubMedGoogle Scholar
  • 23 Kurtz MP, Leow JJ, Varda BK. et al. Robotic versus open pediatric ureteral reimplantation: costs and complications from a nationwide sample. J Pediatr Urol 2016; 12 (06) 408.e1-408.e6
    CrossrefPubMedGoogle Scholar
  • 24 da Cruz JAS, Passerotti CC. Reconstructive laparoscopy in pediatric urology. Curr Opin Urol 2010; 20 (04) 330-335
    CrossrefPubMedGoogle Scholar
  • 25 Silay MS, Spinoit AF, Undre S. et al. Global minimally invasive pyeloplasty study in children: results from the pediatric urology expert group of the European Association of Urology Young Academic Urologists Working Party. J Pediatr Urol 2016; 12 (04) 229.e1-229.e7
    CrossrefPubMedGoogle Scholar
  • 26 Kurtz MP, Leow JJ, Varda BK. et al. The decline of the open ureteral reimplant in the United States: national data from 2003 to 2013. Urology 2017; 100: 193-197
    CrossrefPubMedGoogle Scholar
  • 27 Deng T, Liu B, Luo L. et al. Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis. World J Urol 2018; 36 (05) 819-828
    CrossrefPubMedGoogle Scholar
  • 28 Di Lorenzo N, Coscarella G, Faraci L, Konopacki D, Pietrantuono M, Gaspari AL. Robotic systems and surgical education. JSLS 2005; 9 (01) 3-12
    PubMedGoogle Scholar
  • 29 Grimsby GM, Dwyer ME, Jacobs MA. et al. Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation. J Urol 2015; 193 (5, Suppl): 1791-1795
    CrossrefPubMedGoogle Scholar
  • 30 Akhavan A, Avery D, Lendvay TS. Robot-assisted extravesical ureteral reimplantation: outcomes and conclusions from 78 ureters. J Pediatr Urol 2014; 10 (05) 864-868
    CrossrefPubMedGoogle Scholar
  • 31 Boysen WR, Ellison JS, Kim C. et al. Multi-institutional review of outcomes and complications of robot-assisted laparoscopic extravesical ureteral reimplantation for treatment of primary vesicoureteral reflux in children. J Urol 2017; 197 (06) 1555-1561
    CrossrefPubMedGoogle Scholar
  • 32 Gundeti MS, Boysen WR, Shah A. Robot-assisted laparoscopic extravesical ureteral reimplantation: technique modifications contribute to optimized outcomes. Eur Urol 2016; 70 (05) 818-823
    CrossrefPubMedGoogle Scholar
  • 33 Herz D, Fuchs M, Todd A, McLeod D, Smith J. Robot-assisted laparoscopic extravesical ureteral reimplant: a critical look at surgical outcomes. J Pediatr Urol 2016; 12 (06) 402.e1-402.e9
    CrossrefPubMedGoogle Scholar