Robot-assisted pyeloplasty in ureteropelvic junction obstruction (UPJO): a systematic comparison of single- and multiple-port techniques.

Abstract

In recent years, the utilization of single-port robotic-assisted pyeloplasty (SP-RP) has been growing. However, it is still unclear whether it offers better outcomes relative to multi-port robotic-assisted pyeloplasty (MP-RP). To investigate this, a meta-analysis was executed comparing the perioperative and functional outcomes between SP-RP and MP-RP. We systematically searched SinoMed, Google Scholar, Embase, PubMed, and Scopus, up to June 1, 2025. All outcomes were pooled using a random-effects model, heterogeneity was assessed using both I² and τ². Additionally, sensitivity analyses were executed to stabilize results with high heterogeneity. This meta-analysis included 229 patients from seven studies, who underwent either SP-RP or MP-RP. Regarding surgical success rates, patients undergoing SP-RP or MP-RP demonstrated comparable effectiveness (RR = 1.00, 95% CI 0.96 to 1.06, P = 0.87, I² = 0%, τ² = 0). Compared to patients receiving MP-RP, patients undergoing SP-RP showed similar results in surgery time (WMD = -2.81 min, 95% CI -20.94 to 15.32 min, P = 0.76, I² = 72%, τ² = 409.36), blood loss(WMD =  -3.97 ml, 95% CI -9.25 to 1.30 ml, P = 0.14, I² = 32%, τ² = 12.61), complication rates(RR = 0.90, 95% CI 0.42 to 1.92, P = 0.78, I² = 0%, τ² = 0), length of hospital stay (WMD = -0.42 days, 95% CI -0.90 to 0.06 days, P = 0.09, I² = 74%, τ² = 0.25), pain scores at discharge (WMD = 0.23, 95% CI -0.52 to 0.97, P = 0.55, I² = 37%, τ² = 0.17), and renal function recovery(WMD = 0.79 mL/min/1.73 m², 95% CI -4.59 to 6.17 mL/min/1.73 m², P = 0.77, I² = 67%, τ² = 10.88). Statistically, the differences between the two were not significant. However, during the sensitivity analysis, compared to MP-RP, we found that excluding Beksac's study led to a significantly shorter hospital stay for SP-RP. This exclusion also reduced heterogeneity, resulting in more stable outcomes (WMD = -0.31 days, 95% CI -0.56 to -0.06 days, P = 0.01, I² = 0%, τ² = 0). SP-RP offers comparable effectiveness and safety to MP-RP, with consistently better cosmetic outcomes. A possible reduction in hospital stay was observed only in the sensitivity analysis and should be interpreted with caution.