Comparative outcomes of robot-assisted and open appendicovesicostomy in children: a systematic review and meta-analysis.

PURPOSE: Appendicovesicostomy (APV, Mitrofanoff procedure) is widely performed in children requiring clean intermittent catheterization. This study aimed to systematically compare the perioperative and clinical outcomes of robot-assisted versus open APV in pediatric patients. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to March 2026 for comparative studies evaluating robot-assisted and open APV in children. Primary outcomes included operative time, estimated blood loss, and length of hospital stay. Secondary outcomes included surgical reintervention, channel stenosis, postoperative incontinence, wound infection, and overall complications. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using Review Manager 5.4. RESULTS: Six studies involving 270 pediatric patients (147 robotic and 123 open) were included. There was no significant difference in operative time between the two approaches. Robot-assisted surgery was associated with significantly lower estimated blood loss and shorter hospital stay. No significant differences were observed in surgical reintervention, channel stenosis, postoperative incontinence, wound infection, or overall complications. CONCLUSIONS: Robot-assisted APV is a safe and feasible alternative to the open approach in pediatric patients. It may offer advantages in terms of reduced blood loss and shorter hospital stay while achieving comparable functional and complication outcomes.