ROBOTIC-ASSISTED PYELOPLASTY USING THE DA VINCI SURGICAL SYSTEMS COMPARED TO LAPAROSCOPIC OR OPEN APPROACH: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
Author(s)
Mansi Mathur, MPH1, Ana Yankovsky, MSc2, Usha Kreaden, MSc3;
1Intuitive Surgical, GAEM Data Analyst, Union City, CA, USA, 2Intuitive Surgical, Palo Alto, CA, USA, 3Intuitive Surgical, Sunnyvale, CA, USA
1Intuitive Surgical, GAEM Data Analyst, Union City, CA, USA, 2Intuitive Surgical, Palo Alto, CA, USA, 3Intuitive Surgical, Sunnyvale, CA, USA
OBJECTIVES: The objective was to compare perioperative outcomes of pyeloplasty performed using three surgical methods: da Vinci robotic-assisted surgery (dV-RAS), laparoscopic surgery (LAP), and conventional open surgery.
METHODS: A PRISMA-guided systematic review was conducted using studies from 2010-2024 retrieved from PubMed, Scopus, and Embase. Included studies compared pyeloplasty outcomes between dV-RAS, laparoscopic, and open approaches. Studies were excluded if they were not in English, involved pediatric patients or malignancies, lacked relevant outcomes, or contained duplicate data. The meta-analysis assessed key outcomes including operative time, conversions, transfusions, intraoperative complications, hospital stay, 30-day postoperative complications, surgical site infections (SSI), pain, readmissions, reoperations, and mortality. Categorical outcomes were analyzed using odds ratios (OR) or risk difference (RD), and continuous outcomes using mean difference (MD).
RESULTS: A total of 14 studies were included in the analysis: 1 randomized controlled trial (RCT), 3 prospective, 5 database, and 5 retrospective cohort studies. Overall, dV-RAS and LAP pyeloplasty showed comparable outcomes, with no significant differences observed in operative time, rates of conversion to open surgery, intraoperative complications, length of hospital stay, 30-day postoperative complications, and mortality. Limited evidence from two studies suggests lower reoperation rates with LAP, while insufficient data precluded comparisons of transfusions, pain, 30-day readmissions, and SSI rates between dV-RAS and LAP approaches.Compared to open pyeloplasty, dV-RAS had significantly shorter hospital stay by 1.9 days (MD: -1.88 [-2.87, -0.89; p<0.01) and had favorable blood transfusion rates (RD: -0.0185 [-0.0217, -0.0153], p<0.01). No statistically significant difference was observed in the operative time, intraoperative complications, 30-day SSI and mortality. There was insufficient evidence to assess all other outcomes of interest.
CONCLUSIONS: Pyeloplasty performed using RAS da Vinci system demonstrates non-inferior perioperative outcomes in comparison to standard of care. Further high-quality research, especially on pain and quality of life, is needed to inform cost-effectiveness analyses and support health technology assessment decision making.
METHODS: A PRISMA-guided systematic review was conducted using studies from 2010-2024 retrieved from PubMed, Scopus, and Embase. Included studies compared pyeloplasty outcomes between dV-RAS, laparoscopic, and open approaches. Studies were excluded if they were not in English, involved pediatric patients or malignancies, lacked relevant outcomes, or contained duplicate data. The meta-analysis assessed key outcomes including operative time, conversions, transfusions, intraoperative complications, hospital stay, 30-day postoperative complications, surgical site infections (SSI), pain, readmissions, reoperations, and mortality. Categorical outcomes were analyzed using odds ratios (OR) or risk difference (RD), and continuous outcomes using mean difference (MD).
RESULTS: A total of 14 studies were included in the analysis: 1 randomized controlled trial (RCT), 3 prospective, 5 database, and 5 retrospective cohort studies. Overall, dV-RAS and LAP pyeloplasty showed comparable outcomes, with no significant differences observed in operative time, rates of conversion to open surgery, intraoperative complications, length of hospital stay, 30-day postoperative complications, and mortality. Limited evidence from two studies suggests lower reoperation rates with LAP, while insufficient data precluded comparisons of transfusions, pain, 30-day readmissions, and SSI rates between dV-RAS and LAP approaches.Compared to open pyeloplasty, dV-RAS had significantly shorter hospital stay by 1.9 days (MD: -1.88 [-2.87, -0.89; p<0.01) and had favorable blood transfusion rates (RD: -0.0185 [-0.0217, -0.0153], p<0.01). No statistically significant difference was observed in the operative time, intraoperative complications, 30-day SSI and mortality. There was insufficient evidence to assess all other outcomes of interest.
CONCLUSIONS: Pyeloplasty performed using RAS da Vinci system demonstrates non-inferior perioperative outcomes in comparison to standard of care. Further high-quality research, especially on pain and quality of life, is needed to inform cost-effectiveness analyses and support health technology assessment decision making.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MT13
Topic
Medical Technologies
Disease
SDC: Urinary/Kidney Disorders, STA: Surgery