Robotic upper tract surgery in infants 6 months or less: is there enough space?

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robot-assisted laparoscopic surgery (RALS) has expanded to children under one year old.
• Limited data exist for infants ≤6 months due to anatomical constraints.
• Concerns include limited intraabdominal space and port proximity.

Purpose of the Study:

• To evaluate the feasibility and safety of robotic surgery in infants ≤6 months old.
• To assess the outcomes of robotic urologic procedures in this specific infant cohort.

Main Methods:

• A prospectively collected database of pediatric urologic robotic surgeries was reviewed.
• Included patients were ≤6 months old and ≥4 kg.
• Data analyzed included demographics, intraoperative details, length of stay, and complications.

Main Results:

• Twelve infants ≤6 months underwent robotic urologic surgery (pyeloplasty, ureteroureterostomy, heminephrectomy, nephrectomy).
• Median age was 4.75 months, median weight 7.09 kg.
• No procedures were converted to open; median hospital stay was 24 hours. Four patients (33%) experienced febrile UTI (Clavien grade 2).
• Postoperative ultrasounds showed improved or stable hydronephrosis in 10 patients. No unplanned secondary interventions were required at median follow-up of 19.73 months.

Conclusions:

• Robotic upper urinary tract surgery is feasible and safe in infants ≤6 months old.
• The technique used is comparable to that for older children.
• This approach offers successful outcomes for this young patient group.