Robot-assisted laparoendoscopic single-site versus mini-laparoscopic pyeloplasty: A comparison of perioperative, functional and cosmetic results

Background: New approaches have been developed to further reduce the invasiveness of laparoscopic pyeloplasty (P) as treatment for uretero-pelvic junction obstruction (UPJO). Aim of the study was to compare perioperative, functional and cosmetic results of mini-laparoscopic (mL-P) versus robot-assisted laparoendoscopic single-site P (rLESS-P). Methods: Since April 2009 to June 2010, 12 adult patients with primary UPJO, BMI<25 and no previous abdominal surgeries were enrolled undergoing mLP (3-mm instruments only). With the same indications since February 2012 to October 2013, 15 patients underwent rLESS-P with "single site"® platform (Intuitive Surgery Inc, Sunnyvale, CA, USA). Success of surgeries was determined by clinical parameters and renal scan (success if T 1/2<20 min) at 12 months postoperatively. Demographics and perioperative results were analyzed. Cosmetic results were assessed by using the Patient Scar Assessment Questionnaire (PSAQ). Results: Groups were comparable at baseline. No differences were found in perioperative variables except for a longer operative time in rLESS-P group (128 vs. 190, P<0.001). Postoperative complications rate, analgesic consumption, pain visual analogue scale scores, hospital stay and success rate of surgeries were not significantly different between the groups. PSAQ revealed that in both the groups patients were satisfied with the cosmetic result. At one-year follow-up no recurrences were observed. Semiquantitative analysis of costs revealed an extra-cost for rLESS-P of € 3410 per procedure. Conclusions: In our experience, both mLP and rLESS-P appeared to be feasible and safe in the treatment of UPJO and allowed for excellent cosmetic results. r-LESS required longer operative times and higher costs.