Comparative outcomes of KangDuo and da Vinci robot-assisted ureteral reimplantation: a retrospective cohort study

Abstract

Background Ureteral reimplantation is central to distal ureteral reconstruction, but evidence comparing emerging robotic platforms with the established da Vinci system remains limited. We compared the perioperative safety and mid-term outcomes of KangDuo Surgical Robot-01 (KD-SR-01)-assisted and da Vinci-assisted ureteral reimplantation. Methods We retrospectively analyzed 153 patients who underwent robot-assisted ureteral reimplantation between January 2024 and December 2025. Platform allocation was nonrandom and reflected patient choice after standardized counseling. The primary outcome was mid-term surgical failure, defined as persistent symptoms or radiographic obstruction requiring continued urinary drainage or further intervention; secondary outcomes were operative time, estimated blood loss, postoperative hospital stay, postoperative renal function, and complications. The primary analysis was multivariable regression adjusted for baseline differences in case complexity, with Firth penalized models used for the rare binary outcomes. Propensity score matching was retained as a sensitivity analysis. Results Before adjustment, the da Vinci group had longer strictures [5.0 (3.0–10.0) vs. 4.0 (3.0–5.0) cm; P=0.01] and more previous failed reconstructions (31.4% vs. 13.7%; P=0.03). All procedures were successfully completed without conversion. KD-SR-01 was associated with a longer operative time [adjusted difference, 13.91 minutes; 95% confidence interval (CI): 1.94–25.88; P=0.02]. No significant differences were observed in estimated blood loss, postoperative hospital stay, postoperative serum creatinine, or postoperative estimated glomerular filtration rate. Complications occurred in 3/51 (5.9%) KD-SR-01 and 7/102 (6.9%) da Vinci cases (adjusted odds ratio, 0.91; 95% CI: 0.20–3.49); surgical failure occurred in 1/51 (2.0%) and 2/102 (2.0%), respectively (adjusted odds ratio, 1.20; 95% CI: 0.09–10.93). Results were consistent in the propensity score-matched sensitivity analysis. Conclusions KD-SR-01-assisted ureteral reimplantation is safe and feasible, with perioperative safety and mid-term clinical outcomes comparable to those of da Vinci-assisted surgery. Although the longer operative time with KD-SR-01 may reflect the surgeon's early learning curve and a more methodical operative workflow, these data suggest that the platform may be a feasible alternative in selected reconstructive cases.