Gu Hanxiao, Liu Yi, Lv Jia
Department of Urology, Baoji Hospital of Traditional Chinese Medicine, 58 Xingzheng Avenue, Jintai District, Baoji, 721000, Shaanxi Province, China.
Department of Urology, Lanzhou First People's Hospital, Lanzhou, 730030, People's Republic of China.
J Robot Surg. 2025 Jul 30;19(1):436. doi: 10.1007/s11701-025-02618-5.
Robotic-assisted laparoscopic pyeloplasty (RALP) and conventional laparoscopic pyeloplasty (LP) are widely used surgical techniques for treating pediatric ureteropelvic junction obstruction (UPJO). However, the relative advantages of these approaches remain unclear, and previous meta-analyses have been limited by outdated data and heterogeneous patient populations. This study aims to provide an updated comparison of perioperative and postoperative outcomes between RALP and LP based on studies published in the past decade. We systematically searched PubMed, Scopus, Web of Science, and Google Scholar for studies from January 2015 to March 2025 comparing RALP and LP in pediatric patients. The key outcomes included operative time, hospital stay, stent placement, complications, follow-up duration, and surgical costs. Study quality was assessed using the Newcastle-Ottawa Scale, and data were analyzed with Review Manager 5.4. Heterogeneity was measured using the I statistic. Four retrospective cohort studies involving pediatric patients were included. The baseline characteristics, including age, weight, and BMI, were comparable between the two surgical groups. No significant differences were observed in operative time, stent placement rate, complication rate, or follow-up duration. However, the RALP group showed a significantly shorter hospital stay compared to the LP group. The surgical costs were substantially higher for robotic procedures. The cost comparisons in this study reflect direct procedural expenses only; broader aspects of cost-effectiveness, such as hospital resource utilization and long-term outcomes were not evaluated. High heterogeneity was noted in several outcomes, potentially related to differences in surgical experience, hospital resources, and regional healthcare practices. RALP provides similar safety and operative time to LP, with the benefit of shorter hospitalization. Further large-scale studies are required to confirm these findings and evaluate cost-effectiveness.
机器人辅助腹腔镜肾盂成形术（RALP）和传统腹腔镜肾盂成形术（LP）是治疗小儿肾盂输尿管连接部梗阻（UPJO）广泛应用的手术技术。然而，这些方法的相对优势仍不明确，既往的荟萃分析受到过时数据和异质患者群体的限制。本研究旨在根据过去十年发表的研究，对RALP和LP的围手术期及术后结果进行更新比较。我们系统检索了PubMed、Scopus、Web of Science和谷歌学术，以查找2015年1月至2025年3月间比较小儿患者RALP和LP的研究。关键结局包括手术时间、住院时间、支架置入、并发症、随访时间和手术费用。使用纽卡斯尔-渥太华量表评估研究质量，并使用Review Manager 5.4进行数据分析。使用I统计量测量异质性。纳入了四项涉及小儿患者的回顾性队列研究。两个手术组的基线特征，包括年龄、体重和BMI，具有可比性。在手术时间、支架置入率、并发症发生率或随访时间方面未观察到显著差异。然而，与LP组相比，RALP组的住院时间明显更短。机器人手术的手术费用显著更高。本研究中的费用比较仅反映了直接手术费用；未评估成本效益的更广泛方面，如医院资源利用和长期结局。在几个结局中发现了高度异质性，这可能与手术经验、医院资源和区域医疗实践的差异有关。RALP与LP具有相似的安全性和手术时间，且具有住院时间较短的优势。需要进一步的大规模研究来证实这些发现并评估成本效益。
