ESPU Congress 2017 - Abstract book

166

CONGRESS OF THE ESPU

CONCLUSIONS

Robotic access to the bladder neck region is an excellent option with ideal anatomical exposure

compared to conventional open surgery. It provides an outstanding advantage, especially for obese

patients.

11:14–11:26

Discussion

S15-10 (P without presentation)

IS THERE EVIDENCE FOR PATIENT BENEFIT, USING RAS

FOR PYELOPLASTIES?

Pia LOFGREN

, Gundela HOLMDAHL

, Petteri SJÖGREN

, Henrik SJOVALL

Maud ERIKSSON

and Eva-Lotte DAXBERG

1) Pediatric Urology, Pediatric surgery and urology, Queen Silvias hospital Gothenburg, Sweden, Gothenburg,

SWEDEN - 2) Pediatric urology, Dep of pediatric surgery and urology, Queens Silvias childrens hospital, Gothenburg,

SWEDEN - 3) Oral care AB, Odontology, Gothenburg, SWEDEN - 4) Gastroenterology and hepatology, Internatl

medicine, Gothenburg, SWEDEN - 5) Medical Library Sahlgrenska university hospital, Medical Library, Molndal,

SWEDEN - 6) Medical Library Sahlgrenska university hospital, Medical Library Sahlgrenska university hospital, Molndal,

SWEDEN

PURPOSE

Robotic assisted surgery (RAS) has premise for pediatric urology. It has been adopted for the past

15 years. There are few RCT evaluating RAS in children, even so RAS is a growing modality.

Before introducing the robotic technique in Gothenburg, Sweden, we performed a Health Technology

Assessment analysis that reviews the results of RAS in pyeloplasties in children.

The aim of this systematic review was to study the clinical outcomes and risks focusing on patient

benefit. RAS, conventional laparoscopy and open surgery were compared.

MATERIAL AND METHODS

Systematic literaturesearches were conductedin PubMed,

EMBASE, the Cochrane Library and HTA databases. Articles published between Jan 2000 to Feb

2016 were reviewed.

10 cohort studies and 16 case series fulfilled the criteria; i.e. children10 patients, comparison

between RAS, laparoscopic and/or open technique.

RESULTS

The primary outcome, resolution of hydronephrosis, was not significantly different between the

modalities. Because of poor quality of evidence, it’s uncertain whether RAS reduces postoperative

pain or shortens operation time compared to the other techniques. It is also uncertain whether

length of hospital stay and complication rates differ between the methods.

CONCLUSIONS

The pyeloplasty procedure in pediatric urology can be performed with RAS, conventional laparos-

copy or open surgery.

No documentation proves that any of these techniques is superior to another, regarding the out-

comes mentioned above. The identified studies were cohort studies contributing to very low quality

of evidence according to GRADE. We call for randomized controlled studies.