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Laparoscopic vs. Robotic Pyeloplasty: A Single Surgeon Experience
INTRODUCTION AND OBJECTIVES: Prior literature comparing conventional laparoscopic pyeloplasty (CLP) and robotic assisted laparoscopic pyeloplasty (RAP) operative times and patient outcomes has been confounded by variations in surgeon, institution, and learning curve in addition to other factors. Therefore, the largest-to-date, single-surgeon, retrospective study was conducted to assess impact of procedure type on mean operative times and patient outcomes.
METHODS: 59 Anderson-Hynes transperitoneal pyeloplasty cases from 2005 to 2013 were reviewed retrospectively for perioperative time logs, interoperative complications, and post-surgical follow up imaging notes. A stepwise, multivariate linear regression was calculated from several variables, such as patient’s BMI, age, side, gender, and operative technique (Table 1). 3 cases resulted in lengthy operative times due to a lost needle in soft tissue, bowl injury, and vein perforation. These cases were analyzed separately.
RESULTS: Regression analysis shows statistical significance in surgical procedure time (SPT) of between CLP and RAP (Table 2), the surgeon’s learning curve (linear change over time), as well as of the operative side (Table 3). Left pyeloplasties averaged more time than right (p<.05), respectively (n=27, mean = 295.74, SD = 78.92) / (n=31, mean = 260.00 SD = 100.44). Total operative time (TOT) was statistically significant if a cystoscopy and stent placement was performed (p<.05); however, no other variables yielded significance. Moreover, no significance was found in intraoperative complications or post-surgical flow studies in CLP vs. RAP
CONCLUSIONS: In this study, the institutional setup and surgical skill levels have been controlled to better compare CLP and RAP. We find that CLP has a statistically significant lower mean surgical procedure time (SPT) than RAP. Moreover, we see a stronger relationship when the model accounts for surgeon’s learning curve. Interestingly, may be further interplay in the surgeon’s comfort level or in anatomy leading to the difference in SPT on right vs. left. Importantly, our data concur with others that there is no difference in interoperative complications or post-operative flow success rates between CLP and RAP. RAP may see transitions into tertiary care centers, but potentially increased operative times should be considered.

Table 1: General Patient Data

General Descriptives	Conventional Laparoscopic Pyeloplasty (CLP)	Robot-Assisted Pyeloplasty (RAP)	P-Value
Age in Years: Mean ± SD	37.68 ± 18.20	35.47 ± 18.78	.664
Body Mass Index (BMI): Mean ± SD	26.59 ± 7.91	28.37 ± 6.71	.403
Gender: Male/Female	22/17	7/13	.124
Side: Left/Right	15/24	12/8	.215
Interoperative Complications	3/39	0/20	.210
Post-Operative Failures to Flow	0/30	1/16	.187
Follow Up Time Months: Mean ± SD, n=49	13.59 ± 12.16	11.18 ± 11.91	.519

Table 2: Surgical Procedure Time Data

General Descriptives	Conventional Laparoscopic Pyeloplasty (CLP)	Robot-Assisted Pyeloplasty(RAP)	P-Value
Surgical Procedure Time (SPT) Minutes: Mean ± SD (w/o complications)	252.83 ± 69.48	307.10 ± 97.01	.020*
SPT Minutes: Mean ± SD (w/ complications)	260.61 ± 86.32	307.10 ± 97.06	.067
Total Operative Time (TOT) Minutes: Mean ± SD (controlled for SPT)	311.53 ± 70.45	356.65 ± 84.92	.531

Table 3: Multivariate Linear Regression

Linear Regression Descriptive	P-Value	Correlation Coefficent R
SPT vs. Procedure Type	.016	.327
SPT vs. Procedure Type and Learning Curve	.008**	.415
SPT vs. Procedure Type, Learning Curve, and Operative Side	.002**	.499