Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction

Abstract

Objective: To compare the surgical and functional outcomes of open, laparoscopic and robotic dismembered pyeloplasty for the treatment of patients with ureteropelvic junction obstruction (UPJO). Material and methods:Between 2007 and 2012, a total of 56 patients underwent conventional open (Group 1; n=25), laparoscopic (Group 2; n=16), and robotic (Group 3; n=15) dismembered pyeloplasty operations. Preoperative evaluation was performed using urinalysis, urine culture, blood biochemistry, urinary ultrasound, intravenous pyelogram (IVP) (optional) and Mercaptoacetyltriglycine (MAG-3) renal scan. The mean operation time, estimated blood loss, drain removal time, narcotic analgesic requirements, length of hospital stay and functional outcomes were compared among groups. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) v. 20 (IBM, Armonk, NY, USA) software, and statistically significant differences were determined using a p value <0.05. Results:The mean age of the patients was 30 years in Group 1, 34.3 years in Group 2 and 32.9 years in Group 3. The mean operation time was 127, 130 and 114 min (p=0.32), and the estimated blood loss was 105, 31 and 28 mL, respectively (p=0.001). The drain was removed after 4.36 (±1.3), 2.33 (±0.6) and 1.8 (±0.6) days after surgery (p<0.001), and the mean hospital stay was 4.14 (±1.8), 2.8 (±0.75) and 2 (±1) days, respectively (p<0.001). Narcotic analgesic requirement was significantly higher in Group 1 compared with Groups 2 and 3 (p=0.02). The radiographic and symptomatic success rates were 96% in Group 1, 93.75% in Group 2 and 93.3% in Group 3. Conclusion:Laparoscopic and robotic pyeloplasty are feasible, effective, reliable and minimally invasive treatment approaches for the treatment of UPJO as compared with open dismembered pyeloplasty.

Comparison of the initial operative experience of a single surgeon carrying out robot‐assisted laparoscopic pyeloplasty, laparoendoscopic single‐site pyeloplasty and conventional laparoscopic pyeloplasty

“…The present findings showed that the time taken for port placement in RALP was longer than that in LP. It was pointed out that docking of the robot is thought to take a certain time, especially in facilities with limited experience . It is widely known that the da Vinci System allows surgeons to easily suture, as it is equipped with articulating mechanisms and forceps with a high degree of freedom.…”

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients

“…In another study where robotic pyeloplasty was compared with open, and conventional laparoscopic methods, robotic pyeloplasty was demonstrated as an effective procedure with shorter hospital stays, and healing periods, lower surgical morbidity, and higher success rates. [13] However this study did not analyze, and evaluate cost-effectiveness of the robotic surgery. In addition to its intraoperative advantages, and improved surgical outcomes, higher costs of robotic procedures are more frequently criticized.…”

“…According to the outcomes of these studies robotic pyeloplasty confers important advantages as higher success rates, lower amounts of bleeding, and shorter hospital stay. [13,[16][17][18][19][20][21][22][23] Currently, in centers with adequate experience, and technological facilities, cases with UPJO are tended to be more frequently managed with minimally invasive methods as laparoscopic, and robotic pyeloplasties. In a single-center study, minimally invasive methods used in pyeloplasties were compared.…”

Laparoscopic Pyeloplasty for Ureteropelvic Junctions Obstruction in Adults: 6 Years’ Experience in One Center

“…Furthermore, the robot-assisted procedure has better ergonomics for the surgeon, which improves the success rate of suturing the anastomosis due to more degrees of freedom for movements [5, 9]. …”