BACKGROUND: It is believed that robotic-assisted laparoscopic (RAL) surgery with its enhanced vision and greater degree of movement allows for improved suturing and decreases the lengthy learning time that is needed to master laparoscopic suturing. The purpose of this study is to compare the quality of the suture anastomosis using open, conventional and RAL techniques and to evaluate the associated learning curves.
METHODS: Unilateral dismembered pyeloplasty were performed in 60 pigs by two inexperienced surgeons. In addition, one experienced surgeon performed five pyeloplasties using each of the techniques. The procedural time was recorded. The degree of patency (DP) and the leak point pressure (LPP) of the UPJ were evaluated using antegrade and retrograde urodynamic measurements, immediately after surgery and 2 weeks post-operatively.
RESULTS: Conventional laparoscopic surgery (LS) had the longest procedural time with an steep learning curve for the inexperienced surgeons (r²=0.2). RAL had a longer procedural time compared to open surgery (OS) but was significantly less than that for LS. In addition, the learning curve associated with RAL by the inexperienced surgeons was less steep, approaching that of open surgery (r²=0.007). DP of the UPJ as measured by antegrade urodynamic profile and the LPP as measured by retrograde urodynamic profile was lower in the LS group compared to the RAL and OS group (p=0.001) while in the latter two groups it was comparable ( p=0.49). With the experienced surgeon, both the RAL procedural time and the urodynamic profile of the UPJ approach those of OS group, while they did not for the LS group.
CONCLUSIONS: Suture anastomosis of the UPJ performed by RAL technique is comparable in quality to those done by the open surgical technique and better than those done by conventional laparoscopic technique. In addition, the efficiency of performing suturing using RAL is operator-independent, requires less learning, and is better than those of conventional laparoscopic technique.