A prospective randomised comparison between the transperitoneal and retroperitoneoscopic approaches for robotic-assisted pyeloplasty in a single surgeon, single centre study

Literature data comparing robotic-assisted laparoscopic versus retroperitoneoscopic approaches are still lacking, probably due to difficulties with the retroperitoneoscopic approach. The objective is to compare the results of robotic-assisted pyeloplasty using transperitoneal and retroperitoneal approaches in a prospective randomised single surgeon study. 80 consecutive patients with primary ureteropelvic junction obstruction were prospectively randomised between transperitoneal (40 patients, group 1) and retroperitoneal (40 patients, group 2) robotic-assisted pyeloplasty. All patients underwent preoperative clinical evaluation, retrograde urography, and diuretic isotope renography. All operations were performed by a single-experienced surgeon. Patients were followed up by postoperative clinical examination, sonography, and diuretic renography at 3–6 months. Both approaches were compared with regard to patients’ demographic data, radiological and operative findings, and functional outcomes, and correlations were statistically evaluated. Preoperative demographic, clinical, and renal scintigraphy data were comparable for both groups. No open/laparoscopic conversions were necessary. Mean operative times (skin to skin) were 125 (70–305) and 118 (60–345) min for groups 1 and 2, respectively (p = 0.726). Only minor complications were found in three and four patients from groups 1 and 2, respectively. Pyeloplasty technique included a renal pelvis flap in three patients from either group,; otherwise, the Anderson–Hynes technique was employed. None of perioperative patient and operative parameters, including approach, had a significant impact on operative time or functional outcomes. Median follow-up was 3 months for both groups. Success was recorded in 39 and 38 patients from groups 1 and 2, respectively, while equivocal results were obtained in 3 cases. Postoperative 3 month renal scintigraphy showed no significant GFR or split renal function differences between the groups. There was no detectable postoperative deterioration in ipsilateral split renal function or hydronephrosis grade. Robotic-assisted retroperitoneoscopic pyeloplasty exhibits low morbidity and satisfactory operative and functional outcomes comparable to the usually preferred laparoscopic approach. Robotic-assisted pyeloplasty has high success rates regardless of the used approach. Accordingly, every surgeon should use the approach which he/she feels most comfortable with.