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Laparoscopic pyeloplasty versus robotic pyeloplasty for ureteropelvic junction obstruction: a series of 60 cases performed by a single surgeon.

PURPOSE
To compare operative parameters and outcomes in 30 cases of robotic pyeloplasty (RP) versus 30 cases of laparoscopic pyeloplasty (LP), performed by a single surgeon, for ureteropelvic junction (UPJ) obstruction.


METHODS
Patients with primary UPJ obstruction were included in the study. The same surgeon (AKH) performed RP (usually using a transperitoneal Anderson-Hynes technique) on 30 patients in Group I and employed LP on 30 patients in Group II, in a nonrandomized fashion. The patients were followed for 18 months postoperatively. Three robotic and one assistant port were required in Group I, and 3 or 4 ports were utilized in Group II. In Group I, 26 patients had antegrade double-J stenting, 1 patient had retrograde double-J stenting, and 3 patients had stentless RP. In Group II, 22 patients had antegrade double-J stenting and 8 patients had retrograde double-J stenting.


RESULTS
The mean total operating times were 98 minutes and 145 minutes, the mean estimated blood losses were 40 mL and 101 mL, and the mean hospital stays of the patients were 2 days and 3.5 days, for patients in Group I and Group II, respectively. These patients were followed up postoperatively for 18 months. They received a clinical examination, an ultrasound, and a diuretic renal dynamic scan. At 18 months, imaging studies found no obstructions in the patients in Group I and found an obstruction in only one patient in Group II. One patient in Group II required a repeat open pyeloplasty following failed endoscopic management.


CONCLUSION
In this patient series, UPJ obstruction was managed effectively with either RP or LP, and outcomes were durable. Compared to pure LP, pure RP enabled the surgeon to achieve quicker dissection, reconstruction, and intracorporeal suturing with fine sutures and with antegrade double-J stenting. With RP, the operating time was decreased, and the procedure offered greater ergonomic convenience to the surgeon. Long term postoperative success, however, was equivalent on follow up in both patient groups.