[ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY (RALP) FOR URETEROPELVIC JUNCTION OBSTRUCTION (UPJO) IN THE PEDIATRIC POPULATION: THE FUTURE IS ALREADY HERE].

Abstract

Aims: To evaluate the multi-institutional experience of performing robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) in the pediatric population.

Methods: Beginning in 2016, all children with UPJO, including complex cases, uniformly underwent RALP instead of the previously used laparoscopic or open surgical approaches. This study is a multicenter retrospective chart review. It includes an analysis of demographic data, preoperative, intraoperative, and postoperative parameters, complications, and outcomes.

Results: During an 8-year period, 199 children (76% boys and 24% girls) underwent RALP. This group constitutes the study cohort. Challenging cases included: 24 cases with a weight less than 6 kg, 21 redo RALP procedures following previous open surgery failures, 7 cases of UPJO in the lower pole of a double collecting system, 7 children who underwent simultaneous nephrolithotomy, 7 cases of bilateral UPJO, 3 horseshoe kidneys, 3 single kidneys, and one case of giant hydronephrosis crossing the midline. The median age was 15 months (IQR, 5-43 months) and the median weight was 8.3 kg (IQR, 7-17 kg). The median operative time was 80 minutes (IQR, 64-107 minutes). No significant intraoperative complications were reported, although there was one case of conversion to open surgery due to lack of progress. The median length of hospitalization was 1.4 days (IQR, 1-4 days), with one-third of the children being discharged within 24 hours of the operation. In 18 cases, Clavien-Dindo grade II complications were noted, predominantly postoperative urinary tract infections. At a median follow-up of 20 months (IQR, 15.5-32.5 months), the success rate was 98%, with 4 patients requiring additional procedures due to persistent obstruction.

Conclusions: Robotic-assisted pyeloplasty in children is a safe and effective procedure with a high success rate. RALP can be performed at all ages, including in complex cases. It has become the gold standard at our institutions.