Comparison of robot-assisted and laparoscopic pyeloplasty for primary pediatric ureteropelvic junction obstruction: a retrospective multicenter study

This study aims to compare the clinical outcomes and cost effectiveness of robotic-assisted laparoscopic pyeloplasty (RALP) with laparoscopic pyeloplasty (LP) in children. Retrospective review of patients who underwent RALP and LP for ureteropelvic junction obstruction (UPJO) between October 2020 and March 2023. Patients were stratified into two groups based on the surgical approach: LP group (n = 126) and RALP group (n = 132). Baseline characteristics, perioperative data, success rate, operator and assistant comfort levels, and hospitalization costs were assessed in both groups. All surgeries were successfully completed without any open conversions. There were no significant differences between the LP and RALP groups regarding operative time (116.00 ± 13.86 min vs. 117.60 ± 9.91 min, P = 0.285), estimated blood loss 10.0 (5.0, 20.0) mL vs. 10.0 (5.0, 20.0) mL, P = 0.936 , overall complications (22.22% vs. 23.48%, P = 0.809), and success rates (96.03% vs. 95.45%, P = 0.937). Operator and assistant comfort scores were significantly higher in the RALP group compared to the LP group (8.00 ± 0.82 vs. 5.50 ± 1.11, P < 0.001 and 7.21 ± 0.92 vs. 6.00 ± 0.82, P < 0.001, respectively). The hospitalization cost was significantly higher in the RALP group (56.70 ± 12.82 thousand yuan) compared to the LP group (27.78 ± 9.28 thousand yuan) (P < 0.001). LP and RALP are safe and effective surgical approaches for managing primary UPJO in children. LP remains an equally effective and cost-effective option for pediatric patients with primary UPJO in settings with surgeons possessing advanced laparoscopic skills and for patients without complex anatomy.