Abstract
Background:
Robotic pyeloplasty (RP) has emerged as a preferred surgical approach for treating pelviureteric junction obstruction (PUJO) in adults. While comparisons with open and laparoscopic pyeloplasty (LP) are established in paediatric populations, adult data remain limited. This study aims to compare clinical outcomes of RP and LP in adults and evaluate the learning curve required to achieve proficiency in RP.
Methods:
Retrospective data were collected for 94 consecutive patients undergoing either RP (n = 48) or LP (n = 46) by a single surgeon between June 2008 and June 2021. Variables analysed included demographics, operative time, hospital stay, complications, and postoperative renography findings. RP learning curve was assessed using operative time and analysed with the CUSUM method. Statistical analysis was performed using SPSS v28 and Kruskal–Wallis H test (p < 0.05 significant).
Results:
Mean operative time was significantly lower in the RP group (128.5 minutes) compared to the LP group (169 minutes; p < 0.01). Median hospital stay was shorter for RP (2 days vs 4 days; p < 0.01). Postoperative renography (available in 79% of patients) showed improved drainage in 81% of RP and 78% of LP patients (p = 0.46). Symptom resolution was achieved in 96% of RP and 89% of LP patients (p = 0.11). Thirty-day complication rates were 15% for RP and 22% for LP (p = 0.36). Operative time was analysed using the CUSUM analysis. Phase 1 plateaued at case 16 suggesting initial learning phase complete. Phase 2 with inflection of the curve occurred at case 29 suggesting true mastery.
Conclusion:
RP is a safe, effective procedure offering reduced operative time and hospital stay compared to LP, with comparable functional and symptomatic outcomes. A total of 29 cases are required to achieve proficiency in robotic pyeloplasty. These findings support the broader adoption of RP in adult urological practice.
Level of evidence:
IV.
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