Robot-assisted versus laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: An updated systematic review and meta-analysis

Abstract

Objective.The aim of this study was to perform an updated systematic review and meta-analysis to compare robot-assisted pyeloplasty (RP) with laparoscopic pyeloplasty (LP) with regard to perioperative results. Material and methods. A search was performed for all available studies comparing the effect of RP versus LP for ureteropelvic junction obstruction (UPJO), published up to August 2012 in PubMed, Embase, Cochrane Library and Science Direct. Three reviewers independently conducted the determination of eligibility, quality assessment and data extraction for each study. All analyses were performed with Review Manager 5.1.5.0 software. Results.In total, 12 studies meeting the eligibility criteria were identified for meta-analysis data extraction, including 347 cases of RP and 299 cases of LP. Meta-analysis showed that RP was associated with a 18.76 min reduction in suturing time [weighted mean difference (WMD) = –18.7 6 min, 95% confidence interval (CI) –28.76 to –8.76, p = 0.0002] and a 0.75 day decrease in mean length of hospital stay (WMD = –0.75 days, 95% CI –1.10 to –0.40, p < 0.0001) compared with LP. There were no obvious differences between the approaches in operative time (WMD = –19.44 min, 95% CI –40.20 to 1.31, p = 0.07), complication rate [odds ratio (OR) = 0.65, 95% CI 0.38 to 1.12, p = 0.12] or success rate (OR = 1.32, 95% CI 0.42 to 4.12, p = 0.64). Conclusion. For patients with UPJO, RP appears to achieve equivalent perioperative results to LP, except that RP has a shorter suturing time and shorter length of hospital stay. Given the significant heterogeneity, inevitable selection bias and limited number of studies, more high-quality clinical studies are needed.