Laparoscopic Pediatric Pyeloplasty: Trends in Regions of the Russian Federation

Introduction. The use of minimally invasive surgery of urteropelvic junction obstruction was started in the in the mid-90s of the last century. Replacement rates of open surgery and methods of the minimally invasive surgery are different in various countries. We analyzed the spread of minimally invasive technologies in some regions of the Russian Federation.

Purpose of the study. To study the dynamics of replacement of open pyeloplasty with laparoscopic pyeloplasty in certain regions of the Russian Federation

Material and methods. Available data included the annual number of laparoscopic and open pyeloplasties, patient age, complications, and medium-term results. Our analysis screened 1581 pyeloplasties, which were performed during 2004‒2018 in eight regions of the Russian Federation. The patients were separated into two groups according to age. There were 566 infants and 1015 older children. A total 908 (57.4%) laparoscopic pyeloplasty (LP) and 673 (42,6%) open pyeloplasty (OP) were performed. Of those patients who underwent laparoscopic pyeloplasty, 274 (48.4%) were infants, while 624 (61.5%) were older children. The rates of LP and OP use were then assessed according to year of surgery. A binary logistic regression model was used to evaluate the statistical significance of the rate of LP use over time, to predict postoperative complications and to compare the effectiveness of LP in comparison with OP.

Results. The use of LP increased remarkably during the study period. In regions with 5 years of LP experience, LP utilization rate was significantly higher. The rate of LP in infants has been associated with increasing experience in the LP. A total, 70% of older children and 59% of infants were operated with LP in 8 regions in 2018.

Conclusion. In some regions of the Russian Federation, the rate of LP is markedly increased and almost replaces open surgery. In regions where LP has been introduced over the past 5 years, the replacement rate is higher than in regions where LP was introduced before.

1. Sukumar S, Roghmann F, Sood A, Abdo A, Menon M, Sammon JD, Sun M, Varda B, Trinh Q-D, Elder JS. Correction of Ureteropelvic Junction Obstruction in Children: National Trends and Comparative Effectiveness in Operative Outcomes. J Endourol. 2014;28(5):592‒598. https://doi.org/10.1089/end.2013.0618

2. Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150(6):1795‒1799. https://doi.org/10.1016/s0022-5347(17)35898-6

3. Bondarenko S. G. Optimizacija tehniki laparoskopicheskih operacij pri gidronefroze u detej s vysokim othozhdeniem mochetochnika i peresekajushhimi sosudami. Detskaja hirurgija. 2007;5:12‒16. (In Russ.).

4. Anderson JC, Hynes W. Plastic operation for hydronephrosis. Proc R Soc Med. 1951;44(1):4‒5. PMC2081609

5. Kogan M.I., Sknar A.A., Sizonov V.V., Klyuka I.V., Makarov G.A, Novikova L.V. Original experience in plastic surgery of pelviureteral segment in hydronephrosis in children. Urology. 2005;(3):54‒58. eLIBRARY ID: 17110637

6. Simforoosh N, Basiri A, Tabibi A, Danesh AK, Sharifi-Aghdas F, Ziaee SA, Nooralizadeh A, Hosseini-Moghaddam SM. A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction. Urol J. 2004 Summer; 1(3):165‒169. PMID: 17914681

7. Seixas-Mikelus SA, Jenkins LC, Williot P, Greenfield SP. Pediatric pyeloplasty: comparison of literature meta-analysis of laparoscopic and open techniques with open surgery at a single institution. J Urol. 2009;182(5):2428‒2432. https://doi.org/10.1016/j.juro.2009.07.051

8. Peters CA, Schlussel RN, Retik AB. Pediatric laparoscopic dismembered pyeloplasty. J Urol. 1995;153(6):1962‒1965. PMID: 7752371

9. Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP. Laparoscopic Versus Open Pyeloplasty in Children: Results of a Randomized, Prospective Controlled Trial. J Urol. 2017;197(3 Pt 1):792‒797. https://doi.org/10.1016/j.juro.2016.10.056

10. Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol. 2011;25(5):727‒736. https://doi.org/10.1089/end.2010.0544

11. Kagantsov I.M., A. E. Minin A.E., Sannikov I.A. Rekonstruktivnoplasticheskie operacii pri gidronefroze u detej s primeneniem laparoskopicheskogo dostupa — metod vybora v uslovijah sovremennoj hirurgii. Detskaja hirurgija. 2010;(5):39‒43. (In Russ.). eLIBRARY ID: 15254291

12. Kagantsov I.M., A. E. Minin A.E., Sannikov I.A. Features of drainage of pyelocaliceal system in children after laparoscopic pyeloplasty. Urology. 2013;(5):85‒89. eLIBRARY ID: 21091594 13. Sizonov V.V., Kogan M.I. Laparoskopicheskaja pieloplastika u detej. Obzor literatury. Jendoskopicheskaja hirurgija. 2011;17(6):47‒50. (In Russ.). eLIBRARY ID: 18869199

13. Silaya MS, Spinoitb AF, Undrec S, Fialad V, Tandogdue Z, Garmanovaf T, Guttillag A, Sancaktutarh AA, Haidi B, Waldertj M, Goyalk A, Serefoglul EC, Baldassarrem E, Manzonin G, Radfordo A, Subramaniamo R, Cherianc A, Hoebeked P, Jacobsp M, Roccon B, Yuriyf R, Zattonig F, Kocvarad R, Kohq CJ. 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(4):229. e1-7. https://doi.org/10.1016/j.jpurol.2016.04.007

14. Varda BK, Wang Y, Chung BI, Lee RS, Kurtz MP, Nelson CP, Chang SL. Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015. J Pediatr Urol. 2018;14(4):336.e1-336.e8. https://doi.org/10.1016/j.jpurol.2017.12.010