Safety and Efficacy of Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair in Infants under 1 Year of Age

Abstract

Purpose: Robot-assisted laparoscopic pyeloplasty (RALP) use in children has increased, though many centers still favor open pyeloplasty (OP) in infants. This study aims to compare safety and efficacy of RALP and OP in infants. Materials and Methods: A single-institution, retrospective cohort study of infants <1 year of age who underwent primary RALP or OP between January 2009 and June 2020 was performed. Primary outcomes were intraoperative and 30day complications, postoperative radiographic improvement at last clinic visit, and operative failure leading to redo pyeloplasty. Multivariable logistic regression was performed for 30-day complications to adjust for demographic variation between groups. Survival analysis was performed to compare time to diagnosis of operative failure leading to redo pyeloplasty. Results: Among 204 patients, 121 underwent OP and 83 underwent RALP (74.5% male). RALP patients were older (median 7.2 vs 2.9 months, p <0.001) and larger (median 8.2 vs 5.9 kg, p <0.001) than OP patients. Radiographic improvement was seen in 91.1% of RALP patients and 88.8% of OP patients at last visit. Median (interquartile range) followup in months was 24.4 (10.8e50.3) for the full cohort. In adjusted analysis, the odds of a 30-day complication (OR 0.40, 95% CI 0.08e2.00) was lower for RALP compared to OP, though not statistically significant. In survival analysis, there was no difference in time to diagnosis of operative failure and redo pyeloplasty between groups (p[0.65). Conclusions: RALP is a safe and effective alternative to OP for infants, with comparable intraoperative and 30-day complications, radiographic improvement at last followup, and risk of pyeloplasty failure.

Ureteropelvic junction obstruction in infants: Open or minimally invasive surgery? A systematic review and meta-analysis

“…The mean age at procedure has been reported in nine papers ( 1 , 13 , 22 , 24 – 27 , 30 , 32 ), with no difference between OP infants (4.9 ± 1.4 months) and MIS patients [5.8 ± 2.2 months; p = ns, MD −0.9, 95% CI: (−2.21–0.22), Table 2 and Figure 2 ].…”

“…LAP, and one was excluded ( 31 ) due to incomplete data. Three papers treating OP vs. RALP ( 26 , 30 , 32 ) were included. Two studies compared OP vs.…”

“…Nine articles were included in the meta-analysis, eight retrospective studies ( 1 , 22 , 24 – 27 , 30 , 32 ) and one prospective study ( 13 ).…”

“…The side of the kidney affected by UPJO has been reported in seven papers ( 1 , 22 , 24 – 26 , 30 , 32 ), with 462 patients (279 OP and 183 MIS). Of 279 OP patients, 162 had left kidneys affected (58.1%) and 117 had right kidneys affected (41.9%).…”

“…The length of postoperative follow-up has been reported in five papers (13,25,26,30,32). OP presented a longer but not significant follow-up than MIS [21.5 ± 8.1 months vs. 13.9 ± 4.7 months, respectively; p = ns; MD: 7.03, 95% CI: (−2.23-16.29), Table 2 and Figure Forest plot comparison of the incidence of postoperative complications between OP and MIS in infants.…”