For large renal stone managements, Robotic-assisted pyelolithotomy (RAPL) and mini-percutaneous nephrolithotomy (Mini-PCNL) are two of the mainstream surgical options. While Mini-PCNL is widely used as a first-line treatment, RAPL has emerged as a minimally invasive alternative, especially in complex cases. In this study, we compare the efficacy and safety of RAPL and Mini-PCNL in patients with unilateral renal stones ≥20 mm.

This is a retrospective study that compares the outcomes of RAPL and Mini-PCNL in the patients with unilateral renal stones ≥20 mm treated between December 2016 and November 2023. Eligible patients were screened based on defined inclusion and exclusion criteria. RAPL procedures were performed by a single experienced surgeon using the da Vinci Xi system, while Mini-PCNL was conducted by the endourology team. Standardized surgical techniques, perioperative care, and follow-up protocols were employed. Outcomes such as stone-free rate, complications, and re-intervention within one year were analyzed using chi-square and t-tests with SPSS.

This study compared perioperative and postoperative outcomes between Mini-PCNL (n=574) and RAPL (n=31) in patients with large renal stones. In both groups, the patients have similar baseline characteristics (Table. 1). However, the RAPL patients had more severe hydronephrosis. RAPL showed longer operative time but shorter hospital stays. Moreover, postoperative complications, transfusion rates, and re-intervention rates were significantly lower in RAPL. Stone-free rates were higher in the RAPL group (90.3% vs. 60.8%), indicating superior efficacy (Table. 2). Overall, RAPL demonstrated favorable outcomes in select patients.

RAPL demonstrates higher stone-free rates, fewer complications, and lower re-intervention rates compared to Mini-PCNL, suggesting it may be a safer and more effective option for managing large unilateral renal stones in selected patients.