Robotic assisted laparoscopic pyeloplasty in children

Purpose: Historically, open pyeloplasty has been the gold standard of treatment for ureteropelvic junction obstruction in the pediatric age group. The prospect of using technology such as the robot in this age group has been a concern. Several nonurological robotic procedures have been performed in children. We undertook a retrospective study to evaluate the feasibility and outcomes of robotic assisted laparoscopic pyeloplasty in the pediatric population. Materials and Methods: Seven patients 6 to 15 years old underwent robotic assisted laparoscopic pyeloplasty at our institution between June 2003 and November 2004. All patients underwent dismembered pyeloplasty (Anderson-Hynes). Variables analyzed included length of stay, estimated blood loss, operative time, anastomosis time and docked robotic time. Results: Mean followup was 10.9 months (range 2 to 18). Mean length of stay was 1.2 days (range 1 to 3). Mean operative time was 184 minutes (range 165 to 204), with a mean robotic anastomosis time of 39.5 minutes (30 to 46). Mean estimated blood loss was 31.4 ml (range 10 to 50). Stent size varied from 3.8Fr to 6Fr. Six of the 7 patients have had followup studies demonstrating improved drainage, symptom resolution and no evidence of obstruction on diuretic renal scans or excretory urogram. The remaining patient is awaiting 3-month followup evaluation. Conclusions: Robotic assisted pyeloplasty can be safely performed in the pediatric population. The precision in dissection, incision and suturing allows for comparable results to open pyeloplasty in this age group.