Dismembered pyeloplasty is the preferred treatment for ureteropelvic junction obstruction (UPJO). Minimally invasive procedures, such as laparoscopic surgery, have become the standard due to their surgical benefits over open surgery. However, traditional laparoscopy has limitations, such as restricted instrument movement and poor understanding of 2D imaging systems. Robotic pyeloplasty (RP) and 3D laparoscopic surgery aim to overcome these challenges. In this study, we compare the outcomes of patients who underwent robotic and 2D and 3D laparoscopic pyeloplasty at our center from 2018 to 2022

We included all patients who underwent the first UPJO dismembered pyeloplasty using either robotic or laparoscopic approach between January 2018 and June 2022. All surgeries were performed by the same group of experienced surgeons. Data on anesthesia time, nursing time, surgeon's time, total operation time, and hospital stay were recorded.

A total of 120 patients underwent PUJO surgery between January 2018 and June 2022. Of these, 11 were excluded due to consent issue and not meeting inclusion criteria, 54 patients in the laparoscopic group and 55 patients in the robotic group. There were no significant differences in age, gender, BMI, or side distribution between the two groups. The anesthesia time and surgeon's time were similar in the 2D and 3D laparoscopic groups, but significantly longer in the robotic group. The setup time and total operation time were longer in the robotic group compared to the laparoscopic groups. There were no significant differences in hospital stay among the groups. The success rates of robotic surgery, 3D laparoscopy, and 2D laparoscopy were 96.36%, 89.29%, and 84.62%, respectively, with no statistically significant difference.

In our experience at a tertiary care center, robotic, 3D laparoscopic, and 2D laparoscopic pyeloplasty had comparable outcomes in terms of success rates. Robotic surgery had longer setup and operation times compared to laparoscopic approaches. 3D laparoscopy provided improved depth perception and visualization. The choice between these approaches should be based on surgeon expertise, availability of equipment, and patient factors. Further studies are needed to evaluate long-term outcomes and cost-effectiveness of these techniques.