Meta-analysis Of Robot-assisted Versus Open Pyeloplasty In Children With Ureteropelvic Junction Obstruction

Objective:Nowadays, with the rapidly advances of various minimally invasive techniques, surgical treatments of ureteropelvic junction obstruction(UPJO) have been greatly developed. This paper using evidence-based medicine method aims to systematically review the efficacy and safety of robot-assisted laparoscopic pyeloplasty(RP)versus open pyeloplasty(OP)in children with UPJO.Methods:We did a search in Pubmed, Embase, Ovid, Web of science, Cochrane, CNKI, CBM and Wanfang database for all randomized and non-randomized controlled studies that compared the surgical outcomes of robotic versus open pyeloplasty in children with UPJO. The Retrieval time was up to December 2015. The outcomes were analyzed with Rev Man 5.3 software.Results:Ten non-randomized studies were enrolled, including 274 RP and 396 OP patients. In the RP group, the length of hospital stay was significant shorter than OP group(WMD=-0.86d;95%CI,-1.45~-0.26;P=0.005). But OP group was superior to RP group in operating time(WMD=45.49min; 95%CI, 14.15~76.82;P=0.004)and postoperative complications rate(OR=1.91;95%CI, 1.02~3.60;P=0.04). There were no significant differences between RP group and OP group for operative success rate, blood loss and stent rate. Limited evidence indicates lower opiate analgesia requirement and higher total costs for RP.Conclusion:The operative success rate was similarly in RP and OP group. The complications rate and operating time are higher in the RP group, which maybe due to the inexperience of surgeons and a small operating space in children. In future, robotic-assisted pyeloplasty may be a major treatment for UPJO in children if the higher costs could be overcome and the doctor has experienced in robot.