Anderson-Hynes pyeloplasty remains the gold standard technique for surgical correction, with the transmesocolic and traditional approaches frequently employed in left-sided cases. Optimal access route remains a matter of clinical preference and anatomical suitability. We aimed to compare clinical outcomes between the transmesocolic and traditional approaches in robotic pyeloplasty for left-sided PUJO, with a focus on operative efficiency, recovery, and success rate.

A prospective study was conducted from January 2021 to June 2024 including 60 patients with primary left-sided PUJO. Patients were randomized into two groups: Group A (transmesocolic approach, n=30) and Group B (traditional approach, n=30) by simple randomization. Primary outcomes measured included operative time, intraoperative blood loss, postoperative pain (visual analog scale), hospital stay, and surgical success (defined by symptom resolution and imaging confirmation at 6 months).

Operative time was significantly lower in Group A (110 ± 15 minutes) compared to Group B (135 ± 20 minutes) (p<0.01). Blood loss was reduced in Group A (40 ± 10 mL) vs Group B (60 ± 15 mL) (p<0.05). Postoperative pain scores on day one were lower in Group A (VAS 3.1 ± 0.8) than Group B (VAS 4.2 ± 1.1) (p<0.05). There was no difference noted in time to drain removal, catheter removal and stent removal between two groups. No significant difference noted for intra-operative and post-operative complications. Mean hospital stay was similar across both treatment groups. Success rate at 6 months was slightly higher in Group A (96.7%) compared to Group B (93.3%), though not statistically significant.

Robotic Transmesocolic pyeloplasty demonstrates comparable intraoperative and postoperative outcomes compared to the traditional approach for left-sided PUJO in pediatric patients, without compromising surgical success. Larger cohorts with long term follow up is required to validate the outcomes.