Robot-assisted vs. open ureteric reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis.

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.