Related Experiment Video
Updated: May 20, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective
Bruce W Lindgren1, Jennifer Hagerty, Theresa Meyer
1Division of Urology, Lurie Children's Hospital, Chicago, Illinois, USA.
Insights
Robot-assisted laparoscopic reoperative repair effectively treats failed pyeloplasty in children with recurrent ureteropelvic junction obstruction. This minimally invasive approach offers high success rates and symptom resolution, even after multiple prior surgeries.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Failed pyeloplasty presents a significant management challenge in pediatric urology.
- Treatment options for recurrent or persistent ureteropelvic junction obstruction are limited.
- Reoperative pyeloplasty is often considered for complex cases.
Purpose of the Study:
- To review the experience with robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children.
- To compare robot-assisted laparoscopic repair with other treatment modalities for recurrent ureteropelvic junction obstruction.
- To evaluate the safety and efficacy of robot-assisted laparoscopic reoperative repair in pediatric patients.
Main Methods:
- A retrospective review of pediatric cases undergoing robot-assisted laparoscopic reoperative repair for ureteropelvic junction obstruction between 2006 and 2011.
- Inclusion criteria involved patients with prior open or laparoscopic ureteropelvic junction procedures.
- Detailed analysis of surgical outcomes, operative time, length of stay, and follow-up data.
Main Results:
- Robot-assisted laparoscopic repair was performed in 16 pediatric patients with prior ureteropelvic junction procedures.
- Mean follow-up was 14.9 months, with all symptomatic patients experiencing resolution of symptoms.
- Radiological improvement was observed in 88% of patients, with no further surgical intervention required post-procedure.
Conclusions:
- Robot-assisted laparoscopic reoperative repair is a safe and effective treatment for recurrent/persistent ureteropelvic junction obstruction in children.
- The procedure demonstrates high success rates, comparable to open reoperative repair, with excellent short- and intermediate-term outcomes.
- This minimally invasive approach is suitable even for patients with multiple prior surgical interventions.
Purpose:
Failed pyeloplasty represents a management dilemma, with treatment options including balloon dilation, endopyelotomy and reoperative pyeloplasty. We review our experience with robot-assisted laparoscopic reoperative repair of recurrent/persistent ureteropelvic junction obstruction in children and compare this method to other approaches.
Materials And Methods:
We reviewed in detail all cases of failed prior ureteropelvic junction procedures, either open or laparoscopic, managed by robot-assisted laparoscopic reoperative repair between 2006 and July 2011.
Results:
Robot-assisted laparoscopic repair was performed in 16 cases for persistent or recurrent ureteropelvic junction obstruction following a prior procedure involving the ureteropelvic junction (12 open pyeloplasties, 4 robot-assisted laparoscopic repairs). Additional interventions had been performed in 12 patients. Reoperative robot-assisted laparoscopic pyeloplasty was performed in 13 patients and reoperative robot-assisted laparoscopic ureterocalycostomy in 3. Patient age ranged from 12 months to 15.3 years (mean 6.1 years). Mean operative time and length of stay were 303 minutes and 1.6 days, respectively. Mean followup was 14.9 months. All symptomatic patients had resolution of symptoms postoperatively. A total of 14 patients (88%) had improved radiological findings. One patient underwent transfusion and conversion to an open procedure due to bleeding.
Conclusions:
Robot-assisted laparoscopic reoperative repair of persistent/recurrent ureteropelvic junction obstruction is a safe, highly effective procedure even in the setting of multiple prior procedures. In our series all patients improved symptomatically, 88% improved radiographically and none have required further surgical intervention. Success is greater than with endopyelotomy and comparable to open reoperative repair for this challenging condition during short-term and intermediate followup.