Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients.

Abstract

Ureteropelvic junction obstruction (UPJO) is a frequently found congenital abnormality of the upper urinary tract treated with pyeloplasty. We hereby report a study to compare open pyeloplasty (OP), laparoscopic pyeloplasty (LP) and robotic assisted pyeloplasty (RAP) for UPJO in terms of functional and perioperative outcomes. 102 patients who underwent Anderson-Hynes dismembered pyeloplasty for UPJO were divided into three groups based on type of surgical techniques utilized as follows: OP (Group A; n=34), LP (Group B; n=34), and RAP (Group C; n=34). Preoperative, intraoperative and postoperative data were recorded. The mean operative time was significantly more in the Group B (187.76 min) than the Group A (132.06±30.1 min) and Group C (136.76 ±25.1 min) (p<.001). Mean blood loss was more in OP group 86.47 ±29. 35 ml versus 42.94±20. 77 ml in RAP and 45.59 ±20. 3 ml in the LP group (p< .001). The LP was found to be much tiring. Mean surgeon fatigue index (SFI) calculated was 7±1.1 in the LP group compared to 4.12±1.1 in RAP group and the difference was statistically significant (p< .001). Average VAS score in the first 2 days postoperatively was 6.66±1.58 in the OP group compared to 4.29±1.16 in RAP group and 4.29±1.31 in the LP group (p <0.001). Pyeloplasty has a similar success rate and efficacy irrespective of the technique utilized. RAP improves the surgeons QOL (quality of life) and the fatigue scores, which is useful for surgeon longevity. RAP has become widely favorite and can be considered the approach of choice in the management of UPJO wherever infrastructure and finances allow.