Comparison of long-term outcomes and costs of robot-assisted versus laparoscopic pyeloplasty for ureteropelvic junction obstruction: A single-surgeon cohort study

Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis requiring surgical intervention. While robot-assisted pyeloplasty (RAP) and laparoscopic pyeloplasty (LP) are established minimally invasive techniques, single-surgeon comparative studies focusing on the long-term outcomes and costs remain limited. We aim to present our experience with both RAP and LP from an experienced single surgeon. Between March 2010 and December 2023, 37 patients with UPJO who underwent RAP or LP by a single surgeon at a tertiary center were included in this retrospective cohort study. Patient characteristics, perioperative and long-term outcomes, complications, and costs were evaluated. Among 37 patients, 17 patients received RAP and 20 patients received LP. Median ages were 38.9 years (RAP) and 19.8 (LP; p = 0.094). Median operative times were 175.0 min (RAP) and 208.5 min (LP; p = 0.140). The median hospital stays were 6 days for both group (p = 0.430). No Clavien-Dindo class III or higher complication occurred. After a median follow-up exceeding 5 years, both cohorts demonstrated comparable long-term success rates at 100 % for RAP and 95.0 % for LP (p = 0.357). Median total costs were significantly higher for RAP (9187.41 USD vs 5576.34 USD, p < 0.001). RAP and LP are effective and safe approaches for the management of UPJO, offering comparable long-term success and perioperative outcomes when performed by an experienced surgeon. However, the significantly higher cost of RAP warrants consideration. Our findings emphasize the importance of surgeon expertise and patient-specific factors in surgical decision-making.