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Updated: Apr 16, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Comparing the efficacy and safety between robotic-assisted versus open pyeloplasty in children: a systemic review and
Shang-Jen Chang1,2, Chun-Kai Hsu1,2, Cheng-Hsing Hsieh1,2
1Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan.
Insights
Robotic-assisted pyeloplasty (RP) in children with ureteropelvic junction obstruction (UPJO) shows comparable success to open pyeloplasty (OP) but has higher complication rates and costs. Further improvements are needed for RP to become a preferred minimal invasive option.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children.
- Pyeloplasty is the gold standard surgical treatment for UPJO.
- Robotic-assisted pyeloplasty (RP) offers a minimally invasive approach, but its efficacy and safety compared to open pyeloplasty (OP) require systematic evaluation.
Purpose of the Study:
- To systematically review and compare the efficacy and safety of robotic-assisted pyeloplasty (RP) versus open pyeloplasty (OP) in pediatric UPJO.
- To analyze key surgical outcomes including operative time, hospital stay, complications, and success rates.
Main Methods:
- Systematic literature search of PubMed for randomized controlled trials and comparative studies.
- Independent data extraction and quality assessment by two authors.
- Meta-analysis of data using Cochrane Collaboration Review Manager (RevMan 5.3).
Main Results:
- Analysis of 7 comparative trials and 3 national database studies involving 20,691 patients.
- Robotic-assisted pyeloplasty (RP) was associated with longer operative times and shorter hospital stays compared to open pyeloplasty (OP).
- Postoperative success rates were comparable (RR = 0.99), but RP had significantly higher complication rates (RR = 1.29) and costs.
Conclusions:
- Robotic-assisted pyeloplasty (RP) is a potential alternative minimally invasive surgery for pediatric UPJO.
- Higher complication rates and costs associated with RP need to be addressed for wider adoption.
- Further advancements are necessary to optimize RP outcomes in children with UPJO.
Objective:
This manuscript is mainly to systemically review the published reports that compared the efficacy and safety of robotic-assisted (RP) versus open pyeloplasty (OP) in children with ureteropelvic junction obstruction (UPJO).
Methods:
We did a systemic search in the PubMed(®) for all randomized controlled trials or comparative studies that compared the surgical results of robotic versus open pyeloplasty in children with UPJO. Two of the authors (Hsu and Chang) independently did the literature search, quality assessment, and data extraction. The obtained data were analyzed with Cochrane Collaboration Review Manager (RevMan(®), version 5.3). The end points of the analysis and review included age, operative time, hospital stay, costs, complications, and success rate.
Results:
In total, seven comparative trials and three studies using national database met the criteria that comprised 20,691 (RP:OP = 1956:18,735) patients in the meta-analysis. Most studies reported median value of patient age, operative time, and hospital stay. Only a small proportion of studies could be included for meta-analysis. The enrolled trials revealed that RP was more frequently performed in older children, required longer operative time, and shorter hospital stay. The postoperative success rate was comparable (RR = 0.99, 95 CI 0.94-1.04). Comparing with OP, there was a significant higher complication rate (RR = 1.29, 95 CI 1.10-1.51) and higher costs in the RP group.
Conclusion:
Robotic-assisted pyeloplasty may be a promising alternative minimal invasive surgery for UPJO in children if the higher complication rates and higher costs in the RP can be overcome in the near future.
