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Introduction: Robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (LS) are the main options for ileal ureteral replacement (IUR). It is not clear which option is superior. The purpose of this study is to compare RALS and LS for IUR. Material and methods: We searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Central, and Google Scholar for studies comparing RALS and LS for IUR. The outcomes of interest are operative time, blood loss, postoperative stay, and Clavien-Dindo complications. Meta-analysis was performed with Rev Man version 5.4. Results: We included 36 patients from 3 studies. The mean age was 44 years, with 53% male patients. Blood loss (MD -89.13 cc, CI -129.03 to -49.22, I2 = 0%) was significantly lower in patients undergoing RALS when comparing with LS. No differences were observed when comparing operative time (MD -10.99 minutes, CI -85.66 to 63.59, p = 0.77, I2 = 64%), postoperative stay (MD -2.56 days, CI -8.24 to 3.13, p = 0.38, I2 = 30%), and postoperative complications (OR 1.63, CI 0.27 to 10.02, p = 0.60, I2 = 0%). Conclusions: Overall, we conclude that the robot-assisted technique showed less bleeding compared to the laparoscopic technique.
RESUMO
PURPOSE OF REVIEW: Minimally invasive surgery used to play a role only as a diagnostic tool in pediatric urology, being used in a narrow range of conditions like cryptorchidism. With the breakthrough of laparoscopic techniques, skilled surgeons and remarkably the advances in robotic-assisted surgery, laparoscopy has gained a role for treatment purposes in pediatric urology. RECENT FINDINGS: Many reconstructive laparoscopic procedures notably with the aid of robotic-assisted surgery such as pyeloplasty and ureteral reimplantation and even more challenging procedures like appendicovesicostomy became feasible with similar results to those with open surgery. Even though minimally invasive approaches may have the drawback of greater technical difficulty, they have the advantages of shorter hospital stays, lesser postoperative pain and better cosmesis. SUMMARY: There is still a lack of controlled prospective randomized trials assessing the differences between open and minimally invasive techniques for reconstructive pediatric urology. Nevertheless, the minimally invasive approach has proven itself to be feasible and well tolerated for most reconstructive procedures.