Comparative outcomes and adoption trends of robotic versus non-robotic ureteral reconstruction: a national matched...

The adoption of robotic platforms for ureteral reconstruction has grown considerably over the past decade, yet rigorous comparative data evaluating perioperative safety and longitudinal outcomes relative to non-robotic approaches remain scarce. This study sought to characterize national trends in robotic utilization and compare outcomes between robotic and non-robotic ureteral reconstruction using a propensity-matched national cohort. Adult patients undergoing ureteral reconstruction between 2014 and 2024 were identified within the TriNetX Research Network. Robotic procedures were distinguished using the S2900 billing modifier. Following 1:1 propensity score matching for demographics and key comorbidities, 2,787 patients were included per cohort. Intraoperative, immediate postoperative, 30-day, and two-year outcomes were compared between groups, and annual procedural proportions were analyzed to quantify adoption trends. Robotic ureteral reconstruction rose from 5.8% of all procedures in 2014 to 23.1% by 2024. Compared with non-robotic repair, robotic cases had lower rates of bowel injury (1.2% vs. 2.7%; OR 0.45, p < 0.001), vascular injury (0.5% vs. 2.0%; OR 0.23, p < 0.001), blood transfusion (1.4% vs. 5.0%; OR 0.27, p < 0.001), postoperative ileus (0.6% vs. 1.3%; OR 0.47, p = 0.009), and 30-day readmission (7.9% vs. 12.1%; OR 0.62, p < 0.001). Infection, sepsis, and stent placement rates were comparable. At two years, repeat ureteral procedures and chronic kidney disease rates were similar between groups. Robotic ureteral reconstruction is associated with meaningful reductions in perioperative morbidity while preserving long-term reconstructive outcomes equivalent to non-robotic repair. The decade-long rise in robotic adoption reflects an expanding evidence base supporting its role in complex ureteral disease.