Laparoscopic vs. robot-assisted pyeloplasty: a single-centre outcome analysis with 11 years median follow-up.

INTRODUCTION

Open pyeloplasty was historically the gold standard for pelviureteric junction obstruction. Over the past four decades, minimally invasive approaches, including laparoscopic pyeloplasty (LP) and robotic pyeloplasty (RP), have gained prominence. This study compares long-term functional and surgical outcomes of LP and RP.

METHODS

A retrospective analysis was conducted on patients with PUJO who underwent LP or RP between 2010 and 2015. Preoperative evaluation included CT urography, diuretic renogram, and biochemistry. Postoperative follow-up consisted of clinical examination, renogram, and ultrasonography at 6 months to 2 years, and again at 8–10 years. Operative time, hospital stay, post-operative complications and long-term outcomes were assessed. Exclusion criteria were redo procedures and PUJO with obstructing calculus. Recurrence was defined using objective criteria, including the need for re-intervention or evidence of obstruction on imaging.

RESULTS

Of 189 patients, 89 underwent LP and 100 RP. Paediatric cases comprised 92 patients, with mean ages of 6.96 ± 5.05 years (LP) and 9.04 ± 5.47 years (RP) (p = 0.064). 11 were excluded based on predefined exclusion criteria. A total of 178 patients were included in the analysis. During long-term follow-up, 16 patients were lost to follow-up. Operative time, post-operative complications and hospital stay were comparable between groups. Maximum follow-up was 13.9 years (LP) and 13.2 years (RP). Complications occurred in 10.1% (LP) and 12% (RP); all were grade 1 in LP group, while two patients had grade 3a in RP group. Recurrence occurred in 4 LP and 5 RP patients (p = 0.92). Nine patients underwent surgery in a solitary kidney.

CONCLUSION

Both LP and RP demonstrated durable long-term outcomes at a median follow-up of 11 years, with no statistically significant differences observed in functional or surgical outcomes, within the limitations of the study design.