Surgery · Medical Literature
Robot-assisted vs. open ureteric reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis.
Abstract
The standard surgical approach to the treatment of pediatric VUR is ureteral reimplantation. Although open surgery is still the standard benchmark for its long-term durability and high success rate, the development of minimally invasive techniques led to the creation of laparoscopic ureteral reimplantation. The high learning curve and technical difficulty needed for accurate intracorporeal suturing, however, have limited its widely adopted in clinical practice. Robotic platforms have since emerged as a promising alternative, offering enhanced dexterity and improved visualization, which facilitate complex suturing and achieve success rates comparable to open surgery. However, most available meta-analytical data are limited by high degrees of heterogeneity because previous studies have often combined laparoscopic and robotic procedures and have combined intravesical and extravesical reimplantation. This is a very general classification that can introduce systematic bias and mask underlying differences between modalities. Through this direct comparison of these two specific surgical approaches, the goal of this study is to isolate these variables to provide highly granular, clinically relevant evidence to inform surgical selection for modern practice. We conducted a comprehensive literature search across PubMed, Embase, Web of Science, and the Cochrane Library to identify clinical studies that directly compared the efficacy of RAUR via the extravesical approach with OUR for the treatment of VUR in pediatric patients. For the OUR group, no restriction was placed on the surgical approach, and both extravesical and intravesical techniques were included. The operative time, hospital stay, success rates, and postoperative complications such as urinary tract infection, urinary retention, and other complications were extracted for comparative analysis. A total of 473 patients from seven studies were analyzed. The results of the meta-analysis showed that there was no significant difference between the two groups in terms of total complications, but the RAUR group had significantly longer operative time (WMD = 48.1 min, 95% CI [27.43, 68.76], p < 0.05) and significantly shorter length of hospitalization (WMD = -0.54 days, 95% CI [-0.96, -0.13], p < 0.05) when compared with the OUR group. When assessing surgical success rate, postoperative urinary tract infection, postoperative urinary retention, or overall complications, no significant differences were recorded between the two groups. In summary, these preliminary findings indicate that RAUR is associated with significantly longer operative time, which should be interpreted in the context of the learning curve. Although RAUR showed a statistically shorter hospital stay, the clinical benefit may be limited as most patients were discharged after overnight observation. Success and complication rates, including urinary tract infection and retention, were comparable to OUR, supporting the safety and efficacy of the robotic platform. Given equivalent key outcomes and expected experience accumulation, RAUR may be a viable alternative to OUR. However, owing to inherent confounding factors such as study design and surgical approach variations, these conclusions require further validation through high-quality multicenter randomized controlled trials.
Clinical relevance
In children with vesicoureteral reflux (VUR) requiring surgical correction, does robot-assisted laparoscopic ureteral reimplantation (RALUR) achieve efficacy and safety outcomes comparable to open ureteral reimplantation (OUR) when these two modalities are isolated from laparoscopic procedures and when intravesical and extravesical approaches are analyzed separately? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis","setting":"Not reported; multi-institutional by design (aggregated data from previously published comparative studies)","sampleSize":"Not reported in the available abstract excerpt","population":"Pediatric patients (age <18 years, specific age range not reported) with primary vesicoureteral reflux undergoing surgical ureteral reimplantation; precise inclusion/exclusion criteria not reported in the available abstract","intervention":"Robot-assisted laparoscopic ureteral reimplantation (RALUR), analyzed separately by approach (intravesical vs. extravesical)","comparator":"Open ureteral reimplantation (OUR), analyzed separately by approach (intravesical vs. extravesical)","primaryOutcome":"Not explicitly stated in the available abstract excerpt; presumed to include surgical success rate, perioperative outcomes, and complications based on stated study goals","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
Quantitative results (effect sizes, odds ratios, mean differences, confidence intervals, p-values, and I² statistics) are not available in the truncated abstract provided. The authors' stated methodological contribution is the deliberate isolation of RALUR from laparoscopic ureteral reimplantation (LUR) and the separate analysis of intravesical versus extravesical reimplantation approaches — a design choice intended to eliminate a specific source of systematic bias identified in prior meta-analyses. The abstract characterizes robotic platforms as offering 'enhanced dexterity and improved visualization' facilitating complex suturing, and frames prior pooled estimates as potentially confounded by the admixture of laparoscopic and robotic procedures. No primary outcome data, NNT/NNH, or adverse event rates are reportable from the available text. All specific quantitative findings are not reported in the supplied abstract excerpt.
Practice implications
CRITICAL LIMITATION: Only a truncated abstract is available for this publication; the results and conclusions sections were not included in the provided text, and the full article was not retrievable from indexed sources at the time of this summary. Therefore, no conclusions about efficacy equivalence, superiority, or inferiority of RALUR versus OUR can be drawn from this study as presented. What the abstract does establish is the authors' rationale and methodological framing: prior meta-analyses have been limited by pooling RALUR with laparoscopic ureteral reimplantation (LUR) and by failing to stratify by surgical approach (intravesical vs. extravesical), introducing heterogeneity and potential systematic bias that may have obscured true between-modality differences. The study's stated aim — to provide granular, approach-specific comparative data — addresses a genuine and recognized methodological gap in the existing evidence base. Published comparator literature (not this study) suggests success rates of approximately 92–94% for both OUR and RALUR when broadly pooled, with RALUR associated with longer operative times but shorter hospital stays; however, these figures cannot be attributed to Chen et al. 2026. Whether results of this study are applicable to very young children, those with high-grade (IV–V) or bilateral VUR, or those at centers with limited robotic expertise cannot be determined without the full text. __LIMITATIONS__ Only a truncated abstract was available; results, statistical analyses, heterogeneity assessments, and conclusions are entirely absent from the evaluable text — rendering formal quality appraisal impossible.,Systematic reviews and meta-analyses of ureteral reimplantation are inherently limited by the predominance of retrospective, non-randomized comparative studies in the source literature, introducing selection bias and confounding by indication.,Age and weight differences between RALUR and OUR cohorts (documented in related literature) represent a significant confounding variable if not adequately adjusted for.,Lack of standardized success definition across included studies (radiographic VUR resolution vs. clinical endpoints such as febrile UTI rate) complicates cross-study pooling.,Postoperative voiding cystourethrogram (VCUG) is not uniformly performed across centers, potentially underestimating radiographic recurrence rates in studies using clinical endpoints alone.,High expected heterogeneity (I² not yet reportable) due to variability in surgical technique, surgeon experience/learning curve phase, and center volume — a challenge the authors explicitly acknowledge.,No randomized controlled trial data exist in this field; all meta-analytical estimates derive from observational evidence.,Generalizability is uncertain: centers contributing to such analyses tend to be high-volume robotic programs, which may not reflect outcomes achievable during early institutional adoption of RALUR.,Funding source not reported, precluding assessment of potential sponsorship bias. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This systematic review and meta-analysis by Chen, Li, Xu et al. (Journal of Robotic Surgery, 2026) addresses a recognized methodological gap by directly comparing RALUR with OUR in pediatric VUR while explicitly isolating robotic from laparoscopic procedures and stratifying by reimplantation approach (intravesical vs. extravesical). However, because only a truncated abstract was available, no efficacy or safety data from this study can be reported or acted upon. Clinicians should await access to the full publication before incorporating these findings into practice; the existing body of evidence supports RALUR as a feasible alternative to OUR with comparable success rates at experienced centers, but without the granular approach-stratified data this study aims to provide.