Comparison of Surgical and Functional Outcome of Laparoscopic Pyeloplasty and Robot-assisted Pyeloplasty for Congenital Uretero Pelvic Junction Obstruction

Abstract

Objective:A surge in the easy availability of robotic platforms has resulted in numerous surgical procedures, which were previously done using an open or conventional laparoscopic approach, are now being done using robots worldwide. A prospective randomized study was conducted to compare surgical and functional outcomes of conventional laparoscopic pyeloplasty with robotic-assisted pyeloplasty.Materials and Methods:Patients who require pyeloplasty who presented to our institute between June 2015 and March 2018 were randomized into a robot-assisted or conventional laparoscopic pyeloplasty group. Common steps included a lateral trans-peritoneal approach, intraoperative antegrade double-J stent placement, stent removal at 4 weeks postoperative, and Diethylene Triamine Penta Acetate renogram at 4 weeks post stent removal. Records of intraoperative and postoperative variables were maintained for all patients. The comparison of continuous numerical data was done using the Independent t-test and categorical non-numerical data using the chi-square (χ2) test. P-values of <0.05 were considered significant.Results:This study includes 58 patients who were randomized into two groups with 29 patients each. No significant difference was noted for postoperative variables, such as the visual analog score for pain, drain placement duration, hospitalization duration, and time to return to daily activity. Intraoperative variables, such as total operative time (148.56 minute vs. 114.28 minute, p-value=0.001) and intraoperative blood loss (68.4 mL vs. 59.2 mL, p-value=0.001) were significantly lesser and favored robot-assisted pyeloplasty over conventional laparoscopic pyeloplasty.Conclusion:In favor of robot-assisted pyeloplasty, both statistically and clinically intraoperative time was lesser, but intraoperative blood loss was lesser only statically and not clinically.

Keywords

• laparascopic pyeloplasty
• robotic pyeloplasty
• congenital ureteropelvic junction obstruction