Malhotra Kunal, Panwar Vikas Kumar, Shubhankar Gautam, Mittal Ankur, Mujahid Mohammed Taher
All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Cent European J Urol. 2025;78(2):244-249. doi: 10.5173/ceju.2024.0203. Epub 2025 Apr 30.
Ureteropelvic junction obstruction (UPJO) hinders urine flow from the renal pelvis to the ureter, causing renal dysfunction. Treatment focuses on relieving obstruction to restore urinary drainage and preserve renal function. Robotic-assisted laparoscopic pyeloplasty (RALP) offers enhanced precision compared to laparoscopic pyeloplasty (LP), but limited comparative data exist for adult patients. This study compares RALP and LP outcomes in an adult cohort from a tertiary care centre.
A retrospective cohort analysis was conducted on adult patients who underwent RALP or LP between March 2018 and May 2024. Primary outcome measures included operative time, with secondary outcomes such as estimated blood loss (EBL), hospital length of stay (LOS), complication rates, and success (defined by symptom relief and diuretic renogram improvement). Statistical analysis included Mann-Whitney, χ, and Fisher's exact tests, with a significance threshold of p <0.05.
The study included 128 patients (87 RALP, 41 LP). Operative time was significantly longer for RALP (200.92 ±59.26 minutes) vs LP (161.92 ±55.21 minutes, p <0.001), largely due to robotic docking. Both groups had similar EBL (47.87 ml for RALP vs 45 ml for LP, p = 0.45) and success rates (97.7% for RALP vs 97.4% for LP). However, RALP patients experienced a longer LOS (3.91 days vs 3.41 days, p = 0.001).
RALP demonstrates technical advantages but does not reduce operative time and incurs increased resource utilisation compared to LP. Both techniques achieve high success rates, though further research is needed to assess RALP's cost-effectiveness.
肾盂输尿管连接处梗阻（UPJO）阻碍尿液从肾盂流向输尿管，导致肾功能障碍。治疗重点在于解除梗阻以恢复尿液引流并保留肾功能。与腹腔镜肾盂成形术（LP）相比，机器人辅助腹腔镜肾盂成形术（RALP）具有更高的精度，但针对成年患者的比较数据有限。本研究比较了一家三级医疗中心成年队列中RALP和LP的治疗效果。
对2018年3月至2024年5月期间接受RALP或LP治疗的成年患者进行回顾性队列分析。主要结局指标包括手术时间，次要结局指标如估计失血量（EBL）、住院时间（LOS）、并发症发生率和成功率（通过症状缓解和利尿肾图改善来定义）。统计分析包括Mann-Whitney检验、χ检验和Fisher精确检验，显著性阈值为p<0.05。
该研究纳入了128例患者（87例接受RALP，41例接受LP）。RALP的手术时间（200.92±59.26分钟）明显长于LP（161.92±55.21分钟，p<0.001），这主要是由于机器人对接。两组的EBL相似（RALP为47.87毫升，LP为45毫升，p = 0.45），成功率也相似（RALP为97.7%，LP为97.4%）。然而，RALP患者住院时间更长（3.91天对3.41天，p = 0.001）。
RALP显示出技术优势，但与LP相比，并未缩短手术时间，且资源利用增加。两种技术均取得了较高的成功率，不过仍需进一步研究以评估RALP的成本效益。
