Risk Factors for Prolonged Robot-Assisted Laparoscopic Pyeloplasty: A Single-Center Retrospective Study

Robot-assisted pyeloplasty has become a standard minimally invasive procedure for ureteropelvic junction obstruction; however, factors associated with a prolonged operation remain incompletely understood. In this study, we aimed to identify risk factors for a prolonged operation at a single institution.

We retrospectively reviewed the data of 100 consecutive patients who underwent robot-assisted pyeloplasty at our institution between April 2016 and January 2026. Patients were divided into two groups based on the operative time: the prolonged group (≥ 75th percentile) and the non-prolonged group (< 75th percentile). Clinical and anatomical variables were analyzed, and a multivariable logistic regression model was constructed to identify independent predictors of a prolonged operation.

In the multivariable analysis, high ureteral insertion (odds ratio: 5.6; 95% confidence interval: 1.8-18.3; p = 0.0047), male sex (3.3; 1.2-9.9; p = 0.024), and preoperative ureteral stenting (3.7; 1.32-11.2; p = 0.015) were identified as significant independent predictors of a prolonged operation. Neither postoperative complication rates (p = 0.33) nor surgical success rates (p = 0.25) differed between the groups.

High ureteral insertion, male sex, and preoperative ureteral stenting were significant independent predictors of prolonged robot-assisted pyeloplasty. Nonetheless, these factors were not associated with surgical success or complication rates, confirming the safety and effectiveness of robot-assisted pyeloplasty even in challenging cases.