Short-term outcomes of robotic vs. laparoscopic pyeloplasty: analysis of the NSQIP database

Minimally invasive pyeloplasty is the standard surgical treatment for adult ureteropelvic junction obstruction and can be performed using either robotic-assisted or laparoscopic techniques. However, contemporary national-level data comparing short-term outcomes between these approaches are limited. The primary objective of this study was to determine whether robotic-assisted pyeloplasty is associated with improved 30-day perioperative outcomes compared with laparoscopic pyeloplasty in adults.

We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2022 to 2023. Adult patients undergoing minimally invasive pyeloplasty (CPT 50544) were identified and grouped by surgical approach (robotic vs. laparoscopic). This represented a population-based sample from participating hospitals. Baseline demographics, laboratory values, and NSQIP-predicted risk estimates were compared. Primary outcomes included 30-day postoperative complications, readmission, and reoperation. Secondary outcomes were operative time and length of hospital stay. Multivariable linear and logistic regression models adjusted for age, sex, BMI, ASA class, and race were used to evaluate associations between surgical approach and outcomes.

Among 814 patients, 706 (86.7%) underwent robotic and 108 (13.3%) laparoscopic pyeloplasty. Overall complication rates were low (9.2%) and did not differ significantly between approaches (adjusted OR 1.41, 95% CI 0.86-2.33). Operative time was similar, while length of stay was shorter following robotic surgery (adjusted difference - 0.62 days, 95% CI - 1.02 to - 0.22). Limitations include the retrospective design, lack of long-term functional outcomes, and absence of cost and surgeon-volume data.

Robotic-assisted and laparoscopic pyeloplasty demonstrate equivalent short-term safety and morbidity in adults, with robotic surgery associated with a modestly shorter hospital stay. These findings suggest comparable short-term perioperative safety between approaches in a national cohort, with surgical approach determined by surgeon expertise, institutional resources, and patient preference. Further studies evaluating long-term functional outcomes and cost-effectiveness are warranted.