Robotic-assisted pyeloplasty in children: a systematic review of the literature

Abstract

Robotic pyeloplasty has become a natural progression from the development of open, then laparoscopic procedures to treat pediatric patients with ureteropelvic junction obstruction (UPJO). Robotic-assisted pyeloplasty (RALP) is now considered a new gold standard in pediatric MIS. A systematic review of the literature retrieved from PubMed and published in the last 10 years (2012–2022) was performed. This review underlines that in all children except the smallest infants, where the open procedure has benefits in terms of duration of general anesthetic and there are limitations in the size of instruments, robotic pyeloplasty is becoming the preferred procedure to perform in patients with UPJO. Results for the robotic approach are extremely promising, with shorter operative times than laparoscopy and equal success rates, length of stay and complications. In case of redo pyeloplasty, RALP is easier to perform than other open or MIS procedures. By 2009, robotic surgery became the most used modality to treat all UPJO and continues to grow in popularity. Robot-assisted laparoscopic pyeloplasty in children is safe and effective with excellent outcomes, even in redo pyeloplasty or challenging anatomical cases. Moreover, robotic approach shortens the learning curve for junior surgeons, who can readily achieve levels of expertise comparable to senior practitioners. However, there are still concerns regarding the cost associated with this procedure. Further high-quality prospective observational studies and clinical trials, as well as new technologies specific for the pediatric population, are advisable for RALP to reach the level of gold standard.

Small Scale, High Precision: Robotic Surgery in Neonatal and Pediatric Patients—A Narrative Review

“…Robotic platforms provide enhanced visualization and dexterity, enabling surgeons to perform intricate tasks with greater precision, reducing the risk of complications and improving outcomes. The minimally invasive nature of robotic-assisted procedures is particularly beneficial for pediatric patients, promoting a faster recovery and minimizing postoperative discomfort [ 36 ].…”

“…These modules may include gastrointestinal, thoracic, or neurological surgeries, tailoring the training to the diverse needs of pediatric and neonatal patients. Additionally, workshops focusing on adapting robotic techniques to specific anatomical challenges in younger populations contribute to a more holistic skill set [ 36 , 37 ].…”

“…Robotic-assisted surgery has also found utility in cases of pediatric urological pathologies, such as pyeloplasty for ureteropelvic junction obstruction [ 36 , 51 ]. The intricate nature of urological procedures, coupled with the need for precise suturing and reconstruction, makes robotic assistance valuable in achieving optimal results while minimizing invasiveness [ 52 , 53 , 54 , 55 ].…”

Analysis of outcomes of robot-assisted laparoscopic pyeloplasty in children from a tertiary pediatric center in South India

“…The success rate of pediatric RALP ranges from 90% to 100% ( 2 , 4 , 5 , 7 ). The largest single-institution study revealed a success rate of 96% and a reoperation rate of 3% ( 14 – 16 ). The success rate in our study is 97.8%, with a reoperation rate of 2.1%.…”

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children

“…Fourth, robotic surgery has better ergonomics that helps alleviate the fatigue of surgeons during surgery. Fifth, performing the refined operation in a limited space reduces secondary injuries (6,(14)(15)(16)(17). Finally, the learning curve of robot surgery is short, and is significantly shorter in surgeons with considerable LP experience.…”