Robot-Assisted Versus Laparoscopic Ureteroureterostomy for Duplicated Kidney Malformations in Infants: A Comparative Cohort Study

Objective: The aim of this study was to evaluate the safety and efficacy of robot-assisted laparoscopic ureteroureterostomy (RALUU) and laparoscopic ureteroureterostomy (LUU) for duplicated kidney malformations in infants. Methods: This retrospective comparative cohort included infants with duplicated kidney malformations who underwent RALUU or LUU between May 2021 and April 2025. Perioperative variables assessed included operative duration, blood loss, oral feeding time, FLACC pain score, hospital stay, and complications. Follow-up outcomes included changes in anteroposterior pelvic diameter (APD), ureteral diameter (UD), and renal function (RF) of the affected upper moiety, assessed using renal ultrasonography and radionuclide imaging, with preoperative measurements serving as the baseline reference. The minimum follow-up duration was 12 months. Surgical success was determined based on fulfillment of all three criteria: resolution or alleviation of clinical symptoms, a reduction in APD and UD, and preserved or improved upper-moiety renal function compared with baseline. Results: The final cohort consisted of 52 infants (RALUU, n = 28; LUU, n = 24). Demographic and clinical profiles were comparable between groups. RALUU was associated with a shorter operative duration than LUU (139.6 ± 16.6 vs. 151.8 ± 21.6 min, p = 0.029). Estimated blood loss, time to oral feeding, FLACC pain score, and hospital stay were comparable. Postoperative complications were observed in 2 RALUU patients and 3 LUU patients. One patient in the LUU group developed urine leakage, which was managed conservatively. Postoperative urinary tract infection occurred in 2 patients in each group. No patient required secondary surgery. At a mean follow-up of 26.8 ± 10.4 and 28.1 ± 11.7 months in the RALUU and LUU groups, both groups showed significant reductions in APD and UD, with preserved RF and a modest postoperative increase. Conclusions: Both RALUU and LUU were safe and effective for duplicated kidney malformations in infants. RALUU was associated with a shorter operative time, while postoperative recovery, complication rates, and follow-up outcomes were comparable.