Robotic versus laparoscopic ureteroplasty with a lingual mucosa graft for complex ureteral stricture.

Abstract

Ureteroplasty with a lingual mucosa graft (LMG) for complex ureteral stricture was reported promising. We aimed to compare outcomes of robotic versus laparoscopic ureteroplasty using a LMG (RU-LMG vs. LU-LMG, respectively). From October 2018 to January 2021, 32 ureteroplasties using LMGs were performed by one experienced surgeon, including 16 robotic and laparoscopic procedures each. Patient demographics and peri-operative, post-operative, and follow-up data were prospectively collected and compared. The robotic group had a higher rate of previous reconstruction than the laparoscopic group (62.50% vs. 18.75%; p = 0.012). The stricture length was significantly longer in the robotic group (4.8 ± 1.2cm) than the laparoscopic group (3.7 ± 1.2cm; p = 0.013). All procedures were completed successfully without open conversion. The operative time was shorter in the robotic group (192 ± 54min) than the laparoscopic group (254 ± 46min; p = 0.001). The robotic group had a shorter length of post-operative stay (6.1 ± 2.4 d vs. 8.9 ± 4.3 d; p = 0.033) but a higher hospital cost (76,801 ± 17,974 vs. 42,214 ± 15,757 RMB; p < 0.001) than the laparoscopic group. The mean follow-up time was 21 ± 7months for the robotic group and 29 ± 9months for the laparoscopic group respectively (p = 0.014). No difference was detected in the success rate (93.75% and 100%, respectively; p = 0.309) and complication rate (18.75% and 31.25%, respectively; p = 0.414) between the robotic and laparoscopic groups. Both RU-LMG and LU-LMG are feasible, effective, and safe for repair of complex ureteral strictures. RU-LMG had a shorter operative time and a shorter length of post-operative stay but a higher hospital cost.