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The efficacy of robotic-assisted laparoscopic pyeloplasty for pediatric ureteropelvic junction obstruction: a systematic review and meta-analysis

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Abstract

To evaluate the safety and effectiveness of robotic-assisted laparoscopic pyeloplasty (RALP) for treating pediatric ureteropelvic junction obstruction through an extensive comparison of RALP, open pyeloplasty (OP) and laparoscopic pyeloplasty (LP). We conducted a comprehensive search of the following databases: PubMed, Excerpta Medica Database, Cochrane Library, Web of Science database, China National Knowledge Infrastructure, WanFang Data, and China Biology Medical Disc. Baseline data were compared, the sources of heterogeneity were assessed, and publication biases were detected. This study was registered with PROSPERO (CRD42023415667). 26 studies with 6074 cases performing pyeloplasty were included, and the overall data are comparable. Our analysis showed no significant difference in success rate and postoperative complications between RALP and OP, and RALP is associated with a shorter length of stay (LOS) (MD − 1.00 95%CI − 1.45 to − 0.55, p < 0.0001). In addition, compared to LP, RALP was associated with a shorter anastomosis time (MD − 18.35 95%CI − 29.88 to − 6.82, p = 0.002) and fewer postoperative analgesics (MD − 0.09 95% CI − 0.18 to − 0.01, p = 0.03); however, RALP has a longer operative time (OT) (MD 52.39, 95% CI 39.75–65.03, p < 0.00001) and higher cost. The heterogeneity of OT may be influenced by factors, such as age and region, while the heterogeneity of LOS primarily stems from regional differences. No significant publication bias was detected. Our meta-analysis shows that RALP can be an alternative to OP and LP with a high success rate, minimal postoperative complications, and shorter LOS. In addition, RALP contributes to reduce anastomosis time and postoperative analgesic drugs. However, further well-designed, large-scale, randomized controlled trials with additional parameters are needed to conduct a more comprehensive analysis of heterogeneity.

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Data availability

All data included in this study are available upon request by contacting with the corresponding author.

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Authors and Affiliations

  1. Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Zhongshan 2nd Road, Chongqing, 400014, Yuzhong District, China

    Miao Sun, Chengjun Yu, Jie Zhao, Maolin Liu, Yan Liu, Rong Han, Long Chen & Shengde Wu

  2. Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Miao Sun, Chengjun Yu, Jie Zhao, Maolin Liu, Yan Liu, Rong Han, Long Chen & Shengde Wu

  3. National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Miao Sun, Chengjun Yu, Jie Zhao, Maolin Liu, Yan Liu, Rong Han, Long Chen & Shengde Wu

  4. Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Shengde Wu

  5. China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Miao Sun, Chengjun Yu, Jie Zhao, Maolin Liu, Yan Liu, Rong Han, Long Chen & Shengde Wu

  6. Chongqing Key Laboratory of Pediatrics Chongqing, Children’s Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, Chongqing City, Yuzhong District, China

    Miao Sun, Chengjun Yu, Jie Zhao, Maolin Liu, Yan Liu, Rong Han, Long Chen & Shengde Wu

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Contributions

MS and SW conceive and design the meta-analysis, MS, JZ and ML searched the database and extracted the clinical data. MS, CY, and YL analyzed and interpreted the data, and drafted and revised the manuscript based on feedback. RH and LC assisted with the data acquisition and interpretation. SW assisted with the conception and design, and critical revision of drafts. CY assisted with the language editing. SW provided funding support.

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Correspondence to Shengde Wu.

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Miao Sun, Chengjun Yu, Jie Zhao, Maolin Liu, Yan Liu, Rong Han, Long Chen and Shengde Wu have no relevant conflicts of interest or financial ties to disclose.

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383_2023_5541_MOESM1_ESM.pdf

Supplementary file1 Figure supplementary 1 Galbraith plot of the primary outcome indicators: (a) the success rate of RALP vs OP; (b) the success rate of RALP vs LP; (c) postoperative complications of RALP vs OP; (d) postoperative complications of RALP vs LP; (e) operation time of RALP vs OP; (f) operation time of RALP vs LP; (g) length stay of RALP vs OP; (h) length stay of RALP vs LP. (PDF 2272 KB)

383_2023_5541_MOESM2_ESM.pdf

Supplementary file2 Figure supplementary 2 Forest plot comparisons of LOS for studies comparing (a) RALP vs OP, (b) subgroup analysis of the LOS between RALP and OP, and comparing (c) RALP vs LP, (d) subgroup analysis of the LOS between RALP and LP. (PDF 8894 KB)

383_2023_5541_MOESM3_ESM.pdf

Supplementary file3 Figure supplementary 3 (a) funnel plot of the success rate comparing RALP with LP, (b) trim and fill method of the success rate of comparing RALP with LP, (c) trim and fill method of postoperative complication rate of comparing RALP with LP. (PDF 1613 KB)

383_2023_5541_MOESM4_ESM.pdf

Supplementary file4 Figure supplementary 4 Individual studies: success rate of comparing RALP with LP (a), postoperative complication rate of comparing RALP with LP (b), operation time of comparing RALP with LP (c), LOS of comparing RALP with LP (d), operation time of comparing RALP with OP (e), LOS of comparing RALP with OP (f). (PDF 5436 KB)

Appendix A. Supplementary data

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Sun, M., Yu, C., Zhao, J. et al. The efficacy of robotic-assisted laparoscopic pyeloplasty for pediatric ureteropelvic junction obstruction: a systematic review and meta-analysis. Pediatr Surg Int 39, 265 (2023). https://doi.org/10.1007/s00383-023-05541-8

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