title: Factors that impact the outcome of minimally invasive pyeloplasty: results of the Multi-institutional Laparoscopic and Robotic Pyeloplasty Collaborative Group.
abstract: OBJECTIVE
  We compared laparoscopic and robotic pyeloplasty to identify factors associated with procedural efficacy.
  
  
  METHODS
  We conducted a retrospective multicenter trial incorporating 865 cases from 15 centers. We collected perioperative data including anatomical and procedural factors. Failure was defined subjectively as pain that was unchanged or worse per medical records after surgery. Radiographic failure was defined as unchanged or worsening drainage on renal scans or worsening hydronephrosis on computerized tomography. Bivariate analyses were performed on all outcomes and multivariate analysis was used to assess factors associated with decreased freedom from secondary procedures.
  
  
  RESULTS
  Of the cases 759 (274 laparoscopic pyeloplasties with a mean followup of 15 months and 465 robotic pyeloplasties with a mean followup of 11 months, p <0.001) had sufficient data. Laparoscopic pyeloplasty, previous endopyelotomy and intraoperative crossing vessels were associated with decreased freedom from secondary procedures on bivariate analysis, with a 2-year freedom from secondary procedures of 87% for laparoscopic pyeloplasty vs 95% for robotic pyeloplasty, 81% vs 93% for patients with vs without previous endopyelotomy and 88% vs 95% for patients with vs without intraoperative crossing vessels, respectively. However, on multivariate analysis only previous endopyelotomy (HR 4.35) and intraoperative crossing vessels (HR 2.73) significantly impacted freedom from secondary procedures.
  
  
  CONCLUSIONS
  Laparoscopic and robotic pyeloplasty are highly effective in treating ureteropelvic junction obstruction. There was no difference in their abilities to render the patient free from secondary procedures on multivariate analysis. Previous endopyelotomy and intraoperative crossing vessels reduced freedom from secondary procedures.
authors.affiliation: Indiana University, Indianapolis, IN, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Lucas
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Leveillee
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bird
authors.forename: Mohamed
authors.initials: M
authors.lastname: Aziz
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler
authors.forename: Patrick
authors.initials: P
authors.lastname: Luke
authors.forename: Peter
authors.initials: P
authors.lastname: Erdeljan
authors.forename: D Duane
authors.initials: DD
authors.lastname: Baldwin
authors.forename: Kamyar
authors.initials: K
authors.lastname: Ebrahimi
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadler
authors.forename: David
authors.initials: D
authors.lastname: Rebuck
authors.forename: Raju
authors.initials: R
authors.lastname: Thomas
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Lee
authors.forename: Ugur
authors.initials: U
authors.lastname: Boylu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
authors.forename: Ravi
authors.initials: R
authors.lastname: Munver
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Averch
authors.forename: Bishoy
authors.initials: B
authors.lastname: Gayed
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
authors.forename: Mohan S
authors.initials: MS
authors.lastname: Gundeti
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
authors.forename: J Kyle
authors.initials: JK
authors.lastname: Anderson
authors.forename: Branden G
authors.initials: BG
authors.lastname: Duffey
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.forename: Carson
authors.initials: C
authors.lastname: Wong
authors.forename: Kurt H
authors.initials: KH
authors.lastname: Strom
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D014517:Ureteral Obstruction / Q000601:surgery*