Comparison of robotic-assisted v. laparoscopic pyeloplasty in surgical treatment of pyeloureteral junction obstruction in children

Purpose of this research was to evaluate the perioperative and functional outcomes of robot-assisted and laparoscopic pyeloplasty performed in a specialized pediatric surgical center with the use of the Versius modular & portable surgical robot by “CMR Surgical,” Ltd. (Cambridge, Cambridgeshire, United Kingdom). Material and methods used: Authors present retrospective data on all patients (34) with pyeloureteral junction obstruction who had undergone the Anderson-Hynes pyeloplasty using either robot-assisted or laparoscopic techniques at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Jan. 2020-May 2023. Robotic surgical interventions were performed using the Versius modular & portable surgical robot. All surgical procedures were performed in the manner of the Anderson-Hynes procedure. The study recorded patients' perioperative parameters related to demographics, surgical details and both early and long-term outcomes. Results: all surgical interventions were considered successful based on the fact that the desired result was achieved: a decrease in the size of the pelvis after the surgery. Robot-assisted procedures were performed in 10 and a laparoscopic method was used in 24. The mean age of patients was significantly lower in the laparoscopy group (4.0 [1,9;6,8] y/o v. 11,0 [7,0;15,0] y/o; p=0.001) as was the mean patients’ weight (17. 0 [11.5; 26.8] kg v. 54.6 [29.1; 63.0] kg; p=0.003). The gender composition in both groups was comparable (p=0.252) and demonstrated the dominance of male patients. The indicator of the total duration of surgical interventions was higher in the robot-assisted surgery group (157,5 [128,8; 196,3] minutes v. 117,5 [95.0; 161.3] minutes in the laparoscopy group; p=0,037). The average duration of the installation of the robotic system (i.e. the “docking time”) was 15,0 [10,0; 20,0] minutes. During the study, no statistical difference was found between the length of stay of patients in the intensive care unit (19,0 [16,9; 19,6] minutes v. 19,0 [17.0; 19.0] minutes). There was a significant difference in hospital stay in favor of a reduction in the robot-assisted surgery group (p<0,001), with a median hospital stay after robot-assisted surgery of 7,0 [6.0; 7.0] days, while patients who underwent laparoscopy were discharged only after 14 [13.0; 14.0] days. Authors did register neither early nor late postoperative complications of any kind in both groups. Conclusion: the robotic pyeloplasty is a safe and effective technique for the treatment of pyeloureteral junction obstruction. The robotic approach in the treatment of hydronephrosis in children is accompanied by the benefits of earlier recovery of patients after the surgery which in its turn is confirmed by a shorter time spent both in the intensive care unit and in the hospital.