Comparison of Operative Outcomes for Pediatric Robotic Pyeloplasty between the Da Vinci Si and Xi Surgical Systems
Brian Chun, MD1, Omar Ayyash, MD MPH2, Michael C. Ost, MD MBA2, Francis X. Schneck, MD2, Rajeev Chaudhry, MD2, Glenn M. Cannon, MD2.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND: Robotic-assisted laparoscopic pyeloplasty (RALP) has gained momentum in the treatment of pediatric ureteropelvic junction obstruction (UPJO) with similar outcomes compared to open and laparoscopic approaches. However, robotic surgery has been associated with longer operative time which is major determinant of total surgery cost. The Da Vinci Xi system is the successor to the Si system that provides better robotic arm ergonomics, a mobile boom, and a targeting system designed to streamline robot docking. We hypothesized that these enhancements would reduce overall operative time and the total cost of RALP. Thus, our aim was to compare operative outcomes for pediatric RALP with the Da Vinci Si and Xi systems at our institution.
METHODS: We performed a retrospective cohort study of all pediatric patients undergoing RALP at our institution between 2019-2022. We compared the final 24 months of the Da Vinci Si system to the first 12 months of the Xi system. Bilateral or re-do pyeloplasty, and patients undergoing multiple procedures were excluded. Primary outcomes were operating room (OR) time, estimated blood loss (EBL), and length of inpatient stay. Secondary outcomes included change in hydronephrosis post-operatively. We controlled for surgeon experience, patient age, sex, laterality, reason for presentation, and imaging characteristics.
RESULTS: 101 patients were included with a median age of 6 years (IQR 2-12) and median follow-up of 6 months (IQR 3-14). There were no differences in age at surgery, laterality, sex, reason for presentation, or imaging findings between both cohorts. 92% of patients demonstrated improvement in hydronephrosis post-operatively with no difference based on robotic system. Mean operative time and EBL were lower in the Xi cohort (mean OR time 182 min vs 207 min, p=0.02; median EBL 2 ml vs 5 ml, p=0.02). Length of inpatient stay was similar in both cohorts (p=0.13).
CONCLUSIONS: For pediatric robotic-assisted laparoscopic pyeloplasty, the Da Vinci Xi has a similar high success rate and is associated with shorter operative time and lower EBL compared to the Si system. This reduction in OR time may increase the cost-effectiveness of utilizing a robotic approach.
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