First comparison of open, laparoscopic, and robot-assisted laparoscopic retroperitoneal pyeloplasty for pediatric ureteropelvic junction obstruction at a single institution.

PURPOSE: Open retroperitoneal (OR), laparoscopic retroperitoneal (LR), and robot-assisted laparoscopic retroperitoneal (RR) pyeloplasty (PP) were compared for clinical effectiveness and safety in pediatric ureteropelvic junction obstruction (UPJO) at a single institute.

METHODS

A retrospective review of 80 eligible pediatric UPJO patients treated by PP from 2000 to 2022 (OR: n = 23, LR: n = 33, RR: n = 24) analyzed demographics, hospitalization details, complications (Clavien-Madadi classification), and pre-/postoperative renal function. "Improvement" was defined as postoperative status being at least 5% better than preoperative status. Total anastomotic time (TAT) and TAT/suture were calculated from intraoperative videos for LR and RR.

RESULTS

Hospitalization was significantly shorter in RR compared to OR (median 8 [IQR 7-9.2] vs. 12 [IQR 9-16.5] days; p < 0.01). Seven cases had complications of Clavien-Madadi grade III or higher (OR: 2, LR: 3, RR: 2), but overall complication rates were not significantly different (OR: 35%, LR: 18%, RR: 17%; p = 0.24). Redo surgery for persistent UPJO was required in 4 cases (OR: 2, LR: 1, RR: 1). Although comparable at 24 months, RR demonstrated significantly higher 12-month functional improvement in both SRF (58.3% vs. 34.8% [OR] and 21.2% [LR]; p = 0.016) and GFR (70.8% vs. 39.1% and 27.3%; p = 0.004). TAT and TAT/suture were both significantly shorter with less variance in RR (p < 0.05, respectively).

CONCLUSION

RR provides comparable safety and long-term functional success to OR and LR. However, robotic assistance significantly reduces anastomotic time compared to LR and facilitates earlier functional recovery at 12 months postoperatively.