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ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IS ASSOCIATED WITH HIGHER PARENTAL SATISFACTION AS COMPARED TO OPEN SURGERY: Results FROM THE MODIFIED GLASGOW CHILDREN’S BENEFIT INVENTORY SURVEY
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ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IS ASSOCIATED WITH HIGHER PARENTAL SATISFACTION AS COMPARED TO OPEN SURGERY: Results FROM THE MODIFIED GLASGOW CHILDREN’S BENEFIT INVENTORY SURVEY
Drew A. Freilich, MD, Caleb P. Nelson, MD, MPH, Alan B. Retik, MD, Hiep T. Nguyen, MD.
Children's Hospital, Boston, Boston, MA, USA.
Background
Since its inception, robotic-assisted laparoscopic pyeloplasty (RALP) has rapidly become the minimally invasive surgical intervention of choice for many surgeons based upon its 6-degrees of instrument articulation and 3-dimentional optics greatly facilitating dissection and intracorporeal suturing. The large initial investment in robotic-assisted surgery is frequently justified by its association with decreased postoperative pain, length of hospitalization and improved cosmesis. However, there are no data specifically reporting patient satisfaction with RALP compared to traditional open surgery.
Methods
After Institutional Review Board approval was obtained, a validated satisfaction survey (Glasgow Children’s Benefit Inventory) with an additional 14 questions specific to postoperative satisfaction was mailed to all parents (as patient proxy) of children undergoing either an open or robotic-assisted laparoscopic pyeloplasty between January 2006 and December 2008. Statistical analysis was performed with a 1-sided t-Test. Responses were considered significantly different at p-Value <0.05.
Results
Surveys were mailed to 85 parents in the open group and 61 in the RALP group. Table 1 summarizes patient demographics and responses with a significant difference in parental satisfaction. Reponses to questions to: “affect upon sleeping” and the “impact of surgery upon the parent’s life” also favored RALP, but did not achieve statistical significance. | | | | | Open | RALS | p-Value | | Patient age at surgery (years) | 3.7 | 10.7 | <0.001 | | Number of months postoperative | 10.2 | 11.7 | 0.1751 | | Duration of surgery (hours) | 2.6 | 5.1 | <0.001 | | Length of hospitalization (days) | 3.8 | 2.4 | 0.001 | | Affected the things he/she does?*A | 3.6 | 4.0 | 0.027 | | Made his/her behavior better or worse?*A | 3.3 | 3.8 | 0.022 | | Affected how he/she feels about himself/herself?*A | 3.3 | 3.6 | 0.045 | | Affected how happy and content he/she is?*A | 3.4 | 3.8 | 0.049 | | Affected his/her ability to enjoy leisure activities such as swimming, sports, and general play?*A | 3.2 | 3.8 | 0.006 | | The amount of post-operative pain?+B | 2.9 | 2.2 | 0.041 | | How soon your child returned to normal sports?+C | 3.7 | 4.5 | 0.001 | | The surgery incision scar?+C | 4.0 | 4.5 | 0.018 | | Bold = Favorable Response | | A = Scoring (1= Much Worse -> 5=Much Better) | | B = Scoring (1= Far Less Than Expected -> 5=Far More Than Expected) | | C = Scoring (1=Very Dissatisfied -> 5=Very Satisfied) | | (*)=Validated Question (+)=Supplemental Question |
Conclusions
Parental satisfaction with robotic-assisted laparoscopic pyeloplasty is greater than that of open surgery with respect to amount of post-operative pain and recovery. Interestingly, the differences in satisfaction compared to the open group were not as large as anticipated, suggesting the impact of confounding factors such as age and preoperative parental expectations upon satisfaction. Future large-scale prospective studies are needed to further elucidate the cost benefits of minimally-invasive surgical technology such as robot-assistance.
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