Robotic assisted vs. open ureteral reimplantation in adults: a systematic review and meta-analysis

Abstract

Ureteral reimplantation is a critical surgical procedure for restoring ureteral function, traditionally performed using open ureteral reimplantation (OUR). However, robotic-assisted ureteral reimplantation (RUR) has emerged as a minimally invasive alternative with potential perioperative advantages. To systematically compare the postoperative outcomes and efficacy of RUR and OUR in ureteral reimplantation in adults through a meta-analysis of existing studies. A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library identified studies comparing RUR and OUR in adults up to January 2025. Studies reporting at least one outcome of interest, such as complications, blood loss, hospital stay, or reintervention rates, were included. Pooled effect estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. Four retrospective studies encompassing 258 patients (RUR: 141, OUR: 117) were included. RUR was associated with significantly fewer complications (RR: 0.40; 95% CI: 0.17-0.91; p = 0.03), shorter hospital stays (MD: -4.97 days; 95% CI: -9.55 to -0.38; p = 0.03), and reduced transfusion requirements (RR: 0.09; 95% CI: 0.02-0.46; p = 0.004) compared to OUR. No significant differences were observed in reintervention rates or operating time. RUR demonstrates significant perioperative advantages over OUR, including reduced complications, shorter hospital stays, and lower blood loss, while maintaining comparable long-term efficacy. These findings support the adoption of RUR as a safe and effective alternative for ureteral reimplantation. Further high-quality, multicenter studies are needed to confirm these results and address remaining gaps.

Keywords: Open ureteral reimplantation; Robotic-assisted ureteral reimplantation; Ureteral strictures; Ureteral surgery.

Fig. 1

PRISMA flow diagram of the included studies

Fig. 2

Methodological quality across the studies, according to the Newcastle–Ottawa scale

Fig. 3

Forest plot of need for reintervention

Fig. 4

Forest plot of need for reintervention after excluding Ziewers 2024

Fig. 5

Forest plot of complications

Fig. 6

Forest plot of hospital stay

Fig. 7

Forest plot of operative time

Fig. 8

Forest plot of need for blood transfusion

Fig. 9

Forest plot of estimated blood loss

Fig. 10

Forest plot of estimated blood loss after excluding Ziewers 2024