Comparing laparoscopic pyeloplasty versus robot-assisted laparoscopic pyeloplasty for pelvi-ureteric junction obstruction in infants aged 12 months or less

Abstract

Current literature supports the safety and effectiveness of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) to correct pelvi-ureteric junction obstruction (PUJO) in children. There are scanty data, however, to compare the two approaches in infants. We conducted a retrospective study on 36 consecutive infants aged 12 months or less, who underwent either LP or RALP from Jan 2008 to Jul 2018. LP had been the standard practice until Jan 2014 when it was replaced by RALP. All surgeries were performed by or under the supervision of the same senior surgeon. 22 LP and 14 RALP were successfully performed without any open conversion or intraoperative complications. The median age and body weight at the time of surgery were 6 months (range 2-12) and 8.1kg (range 5.4-10). There was no difference between the two groups in age, body weight, laterality, clinical presentations, and the severity of PUJO in preoperative imaging. The operative success rates were 20/22 (91%) in LP and 13/14 (93%) in RALP (p=0.84). No difference was noted in postoperative complications and analgesic requirement. RALP was associated with a shorter length of stay when compared with LP (3.1±0.3 vs 3.8±1.3 days; p=0.026). While there was no difference in the mean operative time (OT) between the two groups, learning curves plotting the OT against sequential case number suggest a trend of decreasing OT in RALP (p=0.085) when compared with LP. Both LP and RALP are safe and effective in infants. Robotic technology facilitates acquisition of skills in minimally invasive pyeloplasty.