Robotic-assisted versus laparoscopic and open buccal mucosa graft ureteroplasty for complex ureteral strictures: a...

Buccal mucosa graft (BMG) ureteroplasty has emerged as a versatile technique for managing long-segment or complex ureteral strictures. However, the optimal surgical approach-Robotic-Assisted (RAS), Laparoscopic, or Open surgery-remains debated. We aimed to systematically evaluate and compare the perioperative outcomes and safety profiles of these three modalities. A systematic literature search was conducted in PubMed, Embase, and Web of Science up to November 2025, following PRISMA 2020 guidelines. Studies reporting outcomes of BMG ureteroplasty via robotic, laparoscopic, or open approaches were included. The primary outcome was surgical success rate. Secondary outcomes included operative time, hospital stay, and complication rates (total and Clavien-Dindo ≥ 3). Statistical analysis was performed using R software with a Generalized Linear Mixed Model (GLMM). Sixteen studies involving 398 patients (Robotic: n = 256; Laparoscopic: n = 98; Open: n = 44) were included. The pooled surgical success rates were uniformly high across all groups: Robotic (90.4%), Laparoscopic (92.5%), and Open (90.9%), with no statistically significant differences (P > 0.05). However, regarding safety, the robotic approach demonstrated a superior profile. Despite managing complex cases, the robotic cohort exhibited a minimal incidence of major complications (Clavien-Dindo ≥ 3) compared to laparoscopic and open groups. Sensitivity analysis confirmed the robustness of these findings, indicating that the efficacy of RAS is generalizable and not driven by single-center data. Robotic-assisted BMG ureteroplasty achieves excellent functional outcomes comparable to the open gold standard and the laparoscopic approach. In terms of safety, RAS demonstrates a favorable profile with a marked reduction in severe perioperative complications compared to laparoscopic and historical open cohorts. Consequently, RAS represents a safe and effective minimally invasive alternative for complex ureteral reconstruction, offering durability comparable to open repair with minimized morbidity.