title: Comparing the efficacy and safety between robotic-assisted versus open pyeloplasty in children: a systemic review and meta-analysis.
abstract: OBJECTIVE
  This manuscript is mainly to systemically review the published reports that compared the efficacy and safety of robotic-assisted (RP) versus open pyeloplasty (OP) in children with ureteropelvic junction obstruction (UPJO).
  
  
  METHODS
  We did a systemic search in the PubMed(®) for all randomized controlled trials or comparative studies that compared the surgical results of robotic versus open pyeloplasty in children with UPJO. Two of the authors (Hsu and Chang) independently did the literature search, quality assessment, and data extraction. The obtained data were analyzed with Cochrane Collaboration Review Manager (RevMan(®), version 5.3). The end points of the analysis and review included age, operative time, hospital stay, costs, complications, and success rate.
  
  
  RESULTS
  In total, seven comparative trials and three studies using national database met the criteria that comprised 20,691 (RP:OP = 1956:18,735) patients in the meta-analysis. Most studies reported median value of patient age, operative time, and hospital stay. Only a small proportion of studies could be included for meta-analysis. The enrolled trials revealed that RP was more frequently performed in older children, required longer operative time, and shorter hospital stay. The postoperative success rate was comparable (RR = 0.99, 95 CI 0.94-1.04). Comparing with OP, there was a significant higher complication rate (RR = 1.29, 95 CI 1.10-1.51) and higher costs in the RP group.
  
  
  CONCLUSIONS
  Robotic-assisted pyeloplasty may be a promising alternative minimal invasive surgery for UPJO in children if the higher complication rates and higher costs in the RP can be overcome in the near future.
authors.affiliation: Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan.|School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
authors.forename: Shang-Jen
authors.initials: SJ
authors.lastname: Chang
authors.affiliation: Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan.|School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
authors.forename: Chun-Kai
authors.initials: CK
authors.lastname: Hsu
authors.affiliation: Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan.|School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
authors.forename: Cheng-Hsing
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan. krissygnet@gmail.com.|School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan. krissygnet@gmail.com.
authors.forename: Stephen Shei-Dei
authors.initials: SS
authors.lastname: Yang
mesh_terms: D002648:Child; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Children; Meta-analysis; Pyeloplasty; Review; Robotic