Robot-assisted laparoscopic extravesical versus conventional laparoscopic extravesical ureteric reimplantation for pediatric primary vesicoureteric reflux: a systematic review and meta-analysis

To perform a systematic review and meta-analysis comparing the outcomes of robotic-assisted laparoscopic extravesical ureteric reimplantation (RALUR) with conventional laparoscopic extravesical ureteric reimplantation (LEVUR) for primary vesicoureteric reflux in children. We searched the databases to identify all papers of RALUR and LEVUR between 2001 and 2020. Systematic review was performed to identify patient data, age, reflux grades, laterality, duration of surgery, time to discharge, success rate and complications. Heterogeneity was reported with I2 statistics and publication bias was assessed by Doi curve and Luis Furuya-Kanamori index. Pooled data from both groups were compared with Student’s t test and Fisher’s exact test, wherever appropriate. From a total of 43 articles screened, 28 articles were included (18 RALUR and 10 LEVUR). The I2 statistics for RALUR and LEVUR showed heterogeneity of 86% and 25%, respectively. Both groups had comparable minor publication bias. RALUR had higher proportion of grade 5 VUR (p < 0.001) and bilateral reimplantations (p < 0.001). The success rate of RALUR was significantly lower than that of LEVUR (97.6% vs. 93.4%, p = 0.0018). RALUR took a significantly longer duration for surgery compared to LEVUR, both for unilateral and bilateral cases (p < 0.001). The complication rate was not significantly different: 6.6% for RALUR and 5.35% for LEVUR (p = 0.32). The most common complication in both groups was post-operative urinary retention in bilateral cases. Articles on LEVUR reported more consistent success. RALUR series had higher proportion of grade 5 cases and bilateral reimplantations. RALUR reported longer operative time and lower success compared to LEVUR, with a complication rate comparable to LEVUR.