Robotically assisted laparoscopic pyeloplasty: a transatlantic comparison of techniques and outcomes

To report a comparison of two techniques of robotically assisted laparoscopic dismembered pyeloplasty (RALDP), and their associated outcomes, for treating pelvi-ureteric junction obstruction (PUJO), evaluating the potential differences in the initial 50 cases of two centres in North America and Europe.

Between November 2001 and August 2005, 100 patients had transperitoneal RALDP for PUJO in one centre in the USA (group 1) and one in France (group 2). Group 1 consisted of 50 patients (30 males and 20 females, mean age 31 years, range 16-62) and group 2 of 50 patients (17 males and 32 females, one bilateral PUJO; mean age 39 years, range 17-81). The right side was affected in 30 (60%) patients in group 1 and 32 (64%) in group 2. Differences in preoperative evaluation, surgical technique and follow-up were evaluated.

In group 1 all procedures were completed laparoscopically. One conversion was necessary in group 2 due to technical difficulties. The mean operative duration was 122 min (group 1) and 127 min (group 2); the estimated blood loss was negligible (<100 mL) in both groups. Surgical findings included 15 patients with crossing vessels in group 1 and 28 in group 2. There were no peri-operative complications in either group. The mean hospital stay was 1.1 days in group 1 and 5.8 days in group 2, reflecting differences in practice patterns. All patients were asymptomatic at stent removal and in subsequent clinical evaluations in both groups.

The combination of results form both series provide information suggesting that the robotically assisted approach is a viable treatment option. The results reflect some differences in techniques, follow-up and practice patterns, but the outcomes were equally effective on both continents. Further follow-up will allow us to determine the long-term efficacy.