UPMC Children’s Pediatric Urology Team Publishes Study Comparing Outcomes Between Robotic Platforms for Pediatric Pyeloplasty
October 27, 2025
A recent study by the Division of Pediatric Urology at UPMC Children’s Hospital of Pittsburgh and published in the Journal of Pediatric Urology retrospectively evaluated differences in perioperative outcomes and cost for pediatric pyeloplasty between two generations of robotic surgical platforms.
The study was led by first author Brian Chun, MD, former resident in the Division of Pediatric Urology at UPMC Children’s, and senior author Glenn M. Cannon, MD, chief of the Division of Pediatric Urology.
This is the first published study to directly compare the Da Vinci® Si and Xi® systems in the pediatric setting, assessing whether newer design and operational features in the Xi platform translate into improved operative efficiency without compromising outcomes.
“Our aim was to determine whether the technological refinements introduced in the Xi platform had a measurable impact on key surgical metrics, including operative time and costs, while maintaining the high success rate of robotic pyeloplasty,” Dr. Cannon says.
Study Overview
Robotic-assisted laparoscopic pyeloplasty (RALP) has for the most part taken the place of open surgical techniques for pediatric ureteropelvic junction obstruction (UPJO) and has offered comparable success rates with downstream benefits of shorter lengths-of-stay in the hospital and less intense postoperative pain management protocols (i.e., less need for opioid-based analgesics). However, concerns about cost and operative efficiency persist due to the high capital expenses of robotic systems and their maintenance, and the variation in reported operative times across institutions using these systems.
The Da Vinci Xi surgical platform, introduced in 2014, incorporates several enhancements over the older Si system. These include slimmer robotic arms allowing more flexible port placement, laser-guided docking, and an integrated targeting system designed to simplify procedure setup and cut down on delays during procedures.
To evaluate the effect of these changes on patient care, Dr. Cannon and colleagues conducted a retrospective review of 101 RALP cases performed at UPMC Children’s between 2019 and 2022. The study compared the final two years of the team’s experience using the Si system to the first year following adoption of the Xi platform.
What the Study Found and its Potential Clinical Impact
The study conducted by Dr. Cannon and colleagues found that the Xi platform was associated with a statistically significant 25-minute reduction in mean operative time compared to the older Si system (182 minutes vs. 207 minutes). Estimated blood loss was also lower in the Xi patient cohort (2 mL vs. 5 mL), though this difference is not likely to be clinically meaningful in most instances.
The rates of radiographic improvement in hydronephrosis and the median length of stay were similar between the patient groups. Both robotic platforms achieved high success rates overall. The study did not find any difference in operative time across the two Si study years, which supports the interpretation of the findings in that gains in efficiency were related to the Xi system itself, rather than ongoing skill development by the teams using the system.
“The improvement in operative time we observed is a meaningful step toward improving cost effectiveness given the substantial portion of surgical cost tied to the amount of time spent in the operating suite,” Dr. Cannon says.
In this study, the direct operating room utilization costs at UPMC Children’s were approximately $42 per minute, which translates to an estimated $1,050 savings per case based on the average reduction in time in the study’s data.
“Even in academic pediatric settings with modest surgical volumes, enhancing procedural efficiency can help make robotic surgery more sustainable,” Dr. Cannon says. “Technological improvements that simplify docking, reduce supply waste, and improve instrument setups are beneficial gains that directly tie to our field’s ongoing evolution toward improvements in value-based patient care.”
The findings from the study provide an early benchmark for hospitals and health care systems evaluating the operational and financial implications of adopting the latest generation of robotic surgical technology.
Learn More About the Division of Pediatric Urology at UPMC Children’s Hospital of Pittsburgh.
Study Reference
Chun B, Ayyash O, Schneck FX, Chaudhry R, Ost MC, Cannon GM. Comparison of Perioperative Outcomes and Cost for Pediatric Robotic Pyeloplasty Using the Da Vinci SI and Xi Surgical Systems. J Pediatr Urol. 2025 Jul 21: S1477-5131. Online ahead of print.
