Outcomes of robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction with small pelvis in children

Objective To summarize the experience of robotic-assistant laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) with small pelvis in children. Methods A retrospective analysis was performed on clinical data of 12 UPJO children (small pelvis) undergoing RALP from March 2018 to October 2019. Their clinical presentations, operative approaches and follow-up data were analyzed. There were 7 boys and 5 girls with a mean age of 7(4-15) years. The involved side was left (n=9) and right (n=3). Ultrasound at 1-7 days preoperatively indicated anterioposterior diameter (APD) 3.5 cm during an on set of abdominal pain. And radionuclide examination hinted at different declining levels of renal function and the function of affected kidney ranged from 6% to 43%. Results RALP was performed all successfully without a conversion into open surgery. The pathogenesis was simple stricture or torsion (n=3), polyps (n=3), ectopic vascular compression (n=4), calculus incarceration with infection (n=1) and postcaval ureter (n=1). The average operative duration was 165(115-225) min and the average ureteropelvic anastomosis time 50(40-60) min. There were no obvious intraoperative complications and the mean volume of blood loss was <10 ml. The average follow-up period was 12(2-22) months. The mean preoperative value of APD was (1.87±0.57)cm and the mean postoperative value of APD (1.16±0.82)cm (P<0.05). Conclusions Robot-assisted laparoscopic pyeloplasty may be employed for pediatric UPJO with small renal pelvis (APD<2.5 cm). Such a technique is easy to learn and clinical application prospects are excellent. Key words: Child; Robot assisted laparoscopic surgery; Hydronephrosis; Ureteropelvic junction obstruction