Robotic Versus Laparoscopic Technique for Ureteropelvic Junction Obstruction Treatment in Children: A Comparative Study

Abstract

Introduction:

Laparoscopic pyeloplasty (LP) for treatment of ureteropelvic junction obstruction (UPJO) in children offers advantages over open surgical correction, including reduced hospitalization times and lower perioperative morbidity, but presents a long learning curve. Robotic-assisted laparoscopic pyeloplasty (RALP) offers the same advantages with reduced technical operative complexity but entails higher costs. No clear superiority of laparoscopy versus robotic surgery has been established.

Materials and Methods:

We conducted a retrospective comparative cohort study including pediatric patients who underwent minimally invasive pyeloplasty at two tertiary-level centers, those at Evelina Children’s Hospital in London (UK) receiving LP and those at Policlinico San Matteo in Pavia (Italy) undergoing RALP. Data concerning preoperative variables and obstruction severity; intraoperative variables and surgical techniques; degree of postoperative obstruction reduction, complications, and redo surgeries were analysed.

Results:

A total of 75 patients were included, with 47 undergoing LP and 28 receiving RALP, with similar preoperative characteristics across groups. The Anderson-Hynes surgical technique was employed in 71/75 cases (94.7%) with universal stent use. No conversions were recorded. Mean operatives times and postoperative length of stay were longer for RALP. Complications took place in 7/28 (25.0%) of RALP patients and 6/47 (12.7%) of LP patients. Redo surgery was needed for 1/28 (3.6%) RALP and 3/47 (6.4%) LP patients. These differences were not statistically significant. Symptoms resolution and postoperative pelvic diameter decrease were comparable between groups.

Conclusions:

RALP and LP appeared comparable in terms of safety and efficacy. Adoption of one technique over the other may be justified by the surgeon’s preference and the availability of a robot.