Robotic-assisted ureteric reimplantation versus laparoscopic and open approaches: systematic review and meta-analysis.

Ureteric reimplantation is technically demanding, and comparative outcomes across robotic-assisted, laparoscopic, and open approaches remain uncertain. We performed a PRISMA-compliant systematic review and meta-analysis of comparative studies identified from PubMed, Embase, Web of Science, and the Cochrane Library (inception to 20 January 2026). Random-effects models pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Indirect laparoscopic-versus-open estimates were derived using robotic-assisted surgery as the common comparator (Bucher method). 14 retrospective comparative studies were included. Compared with laparoscopy, robotic-assisted ureteric reimplantation was associated with shorter operative time (MD = − 37.50 min, 95% CI − 50.36 to − 24.65, p < 0.001, I2 = 0%), lower estimated blood loss (MD = − 41.33 mL, 95% CI − 80.06 to − 2.60, p = 0.04, I2 = 83%), and earlier drain removal (MD = − 1.48 days, 95% CI − 2.12 to − 0.85, p < 0.001, I2 = 0%). Versus open surgery, robotic assistance was associated with a shorter length of hospital stay (MD = − 4.72 days, 95% CI − 6.69 to − 2.76, p < 0.001, I2 = 98%). In indirect comparisons, laparoscopy was associated with longer operative time than open surgery (MD = 44.64 min, 95% CI 5.03 to 84.26, p = 0.02) but shorter hospitalization (MD = − 4.12 days, 95% CI − 6.33 to − 1.90, p = 0.0003). Robotic-assisted ureteric reimplantation was associated with improved perioperative efficiency compared with laparoscopy and shorter hospitalization compared with open repair, while success and complication rates were broadly comparable across approaches. Interpretation is limited by retrospective designs, heterogeneity, and low to very low certainty of evidence.