Robot-assisted and laparoscopic pyeloplasty in children: a comparative analysis of surgical outcomes

Introduction. Ureteropelvic junction obstruction (UPJO) is the most common indication for surgical intervention in the upper urinary tract in paediatric patients. We conducted a comparative analysis of outcomes following robotassisted laparoscopic pyeloplasty (RAP) using the da Vinci Xi system versus conventional laparoscopic pyeloplasty (LaP).

Objective. To comparatively evaluate the outcomes of RAP and LaP in children.

Materials & Methods. The study included 40 patients who underwent pyeloplasty. Patients were divided into two groups: Group 1 comprised 20 patients treated with RAP, and Group 2 comprised 20 patients treated with LaP. All procedures were performed by the same surgeon.

Results. There were no conversions in either group. In the RAP group, the mean operative time was 144.2 ± 25.9 min; docking time averaged 21.7 ± 2.6 minutes; and console time for the surgeon was 87.8 ± 20.4 min. In the LaP group, the mean operation duration was 121.8 ± 39.9 min; average surgeon time was 90.0 ± 20.0 min. The mean postoperative hospital stay was 6.6 ± 1.4 days after RAP and 7.5 ± 2.8 days after LaP (p = 0.198). At six months post-pyeloplasty, the mean anteroposterior renal pelvic diameter was 18.3 ± 11.3 mm in Group 1 and 19.7 ± 6.1 mm in Group 2 (p = 0.632).

Conclusion. Comparative analysis of the efficacy and safety of RAP and LP for UPJO in children reveals comparable results in operative duration and postoperative regression of pelvicalyceal dilatation in both groups. A key advantage of RAP over LaP is the preservation of the surgeon’s physical condition throughout anastomosis formation, enabling maximal precision and avoiding compromises between desired intracorporeal suture quality and actual outcomes, which are otherwise limited by the inevitable physical fatigue associated with laparoscopic access.

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