Transperitoneal versus low anterior access single-port pyeloplasty: surgical and functional outcomes from a tertiary referral center.

Background: Transperitoneal approach to robot-assisted pyeloplasty (RAP) have been preferred in the last decades because of the use of multi-port robotic platforms. However, this approach is linked to notable issues, such as pneumoperitoneum and lateral decubitus position, which is associated with potential soft tissues injuries, and it is a time-consuming procedure. Single-port (SP) platform was introduced to potentially address these issues. Our aim was to describe perioperative surgical and functional outcomes of SP-RAP, including our preliminary results comparing the transperitoneal and LAA approaches.

Methods: Data from a prospectively maintained dataset of all consecutive patients undergoing SP-RAP between 2019 and 2024 were retrospectively reviewed. Early procedures were performed using transperitoneal midline access, while later procedures utilized the low anterior access (LAA) approach. Patients' demographics, perioperative data, and surgical and functional outcomes were collected.

Results: Overall, 34 patients underwent the procedure without intraoperative complications or conversion to an alternative approach. The median age was 46.5 (range: 35-56) years. The transperitoneal approach was used for the first 17 (50%) procedures, while the remaining 17 (50%) underwent LAA SP-RAP. Nonoperative room time, postoperative opioid dose, and length of hospital stay were significantly lower in the LAA group (P<0.001 in all cases), with all patients in the LAA group being discharged on the same day. No differences were observed in operative time or postoperative renal function.

Conclusions: Outcomes for SP pyeloplasties appear promising, and the LAA approach may help optimize operating room time, promote faster patient recovery, and reduce postoperative opioid use.