Outcomes and evidence

Headline numbers

• Robotic pyeloplasty: long-term success above 95% in published series⁵, with shorter hospital stay and faster recovery than open surgery.
• Laparoscopic pyeloplasty: similar long-term success to robotic in experienced hands⁴, but longer operative time and a technically harder join.
• Open pyeloplasty: long-standing gold standard in the era before keyhole surgery, with similar long-term success to robotic repair but a 7 to 10 day hospital stay and a 2 to 3 month recovery¹.
• Laser endopyelotomy: pooled success around 75%³, higher rates of needing further treatment than pyeloplasty⁶.
• Dr Kooner's NSW series: robotically-assisted laparoscopic pyeloplasty using the fourth robotic arm, with complete relief of obstruction in all patients treated².

Robotic vs laparoscopic

Kumar and Nayak⁴ compared robotic and conventional laparoscopic pyeloplasty in a single-surgeon cohort. The robotic approach gave a shorter operative time, a shorter hospital stay, and an equivalent success rate. That matches Dr Kooner's own experience: the robot's three-dimensional view, 10× magnification, and articulated wrist allow a more precise, watertight join than straight laparoscopic instruments can.

Robotic vs open

Moretto and colleagues⁵ published a 2023 comparison of perioperative and functional outcomes for robotic and open pyeloplasty. Long-term success was similar between approaches. The robotic repair delivered less post-operative pain, fewer wound complications, shorter hospital stay, and a quicker return to normal activity. On the strength of that evidence, robotic repair is now the preferred reconstruction where available.

Endopyelotomy vs pyeloplasty

Elmussareh and colleagues³ systematically reviewed adult laser endopyelotomy results. The pooled success rate was about 75%. Better results were seen with shorter narrowings and worse results when a crossing vessel was present. Jacobs and colleagues⁶ looked at comparative effectiveness and found that patients treated with endopyelotomy were more likely to need a further procedure than those treated with reconstructive pyeloplasty.

Dr Kooner's series

Al-Sameraaii, Raman, Yuen and Kooner² published the NSW series of the first nine consecutive robotically-assisted laparoscopic pyeloplasties performed using the fourth robotic arm for bowel retraction during dismembered pyeloplasty. All nine patients had complete relief of obstruction at follow-up. The series has been presented nationally and internationally.