Comparing the Quality of the Suture Anastomosis and the Learning Curves Associated with Performing Open, Freehand, and Robotic-Assisted Laparoscopic Pyeloplasty in a Swine Animal Model

Abstract

BACKGROUND: It is believed that robotic assistance allows for improved suture reapproximation of tissue and decreases the lengthy learning time that is needed to master laparoscopic suturing. But there have been no studies directly comparing the efficiency of robotic-assisted laparoscopic surgery (RALS) to freehand laparoscopy (LS) and open surgery (OS). The purpose of this study was to compare the quality of the suture anastomosis of the ureteropelvic junction (UPJ) using the three techniques and to evaluate their associated learning curves. STUDY DESIGN: The operative time for dismembered pyeloplasties performed in 57 pigs by 3 inexperienced and 1 experienced surgeon using each of the techniques was measured. The anastomosis was evaluated for water tightness and patency using antegrade and retrograde urodynamic measurements immediately after surgery and 2 weeks postoperatively. The histology of the operated UPJ was also evaluated at 15 days postoperatively. RESULTS: RALS had a shorter procedural time and less steep learning curve compared with LS. Urodynamic measurements for patency and water tightness of the UPJ were comparable to those in the OS group. But with experience, both the RALS and LS procedural times and the urodynamic measurements for water tightness and patency of the UPJ approached those of the OS group. Histologic evaluation demonstrated that there was less collagen III deposition around the operated UPJ in pigs that underwent RALS compared with LS and OS. CONCLUSIONS: Among inexperienced surgeons, the efficiency of performing suturing using RALS is operator independent, requires less time to learn, and is better than those done by LS technique.