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Updated: Oct 12, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Systematic Review and Meta-Analysis of Pediatric Robot-Assisted Laparoscopic Pyeloplasty
David Greenwald1, Amrita Mohanty1, Ciro Andolfi1
1Pediatric Urology, Section of Urology, Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Comer Children's Hospital Chicago, IL, USA.
Insights
Robot-assisted laparoscopic pyeloplasty (RALP) shows a high success rate of 95.4% for pediatric ureteropelvic junction obstruction. While effective, further research is needed to compare RALP with other surgical approaches.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in children.
- Robot-assisted laparoscopic pyeloplasty (RALP) is an increasingly utilized surgical technique for UPJ obstruction.
- Evidence regarding the outcomes of RALP in pediatric populations requires systematic evaluation.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of outcomes associated with robot-assisted laparoscopic pyeloplasty (RALP) in children with ureteropelvic junction (UPJ) obstruction.
- To synthesize current evidence on surgical techniques, perioperative outcomes, success rates, and complications of pediatric RALP.
Main Methods:
- A systematic review of English-language literature was performed using MEDLINE, EMBASE, and Cochrane databases (July 2020).
- Included studies focused on surgical techniques and perioperative outcomes of RALP for UPJ obstruction in children.
- Forty-six studies were included in the meta-analysis, with evidence quality assessed using the Modified Newcastle-Ottawa Scale.
Main Results:
- The mean success rate for RALP in pediatric UPJ obstruction was 95.4% (95% CI: 91.0%-99.3%).
- The majority of studies reported a short length of stay (approximately 1 day).
- The overall mean complication rate was 12%, with a mean low-grade (Clavien Grade ≤2) complication rate of 9.3% and a mean high-grade (Clavien Grade ≥3) complication rate of 6.5%.
Conclusions:
- Robot-assisted surgery is technically feasible and demonstrates favorable outcomes for pediatric pyeloplasty.
- The current evidence base is largely derived from retrospective, single-institution studies, introducing potential biases.
- Further prospective, multi-institutional studies with standardized reporting are recommended to definitively establish the benefits and limitations of RALP compared to open and laparoscopic approaches.
Abstract:
To perform a systematic review (SR) and meta-analysis (MA) of outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction (UPJ) obstruction in children. A SR of the English-language literature on surgical techniques and perioperative outcomes of RALP for UPJ obstruction in children was performed without time filters using the MEDLINE (through PubMed), EMBASE, and Cochrane databases in July 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement recommendations. Overall, 58 studies were selected for qualitative analysis, 46 of which were included in the MA. Nearly all studies included were observational and retrospective, either cohort or case-control. The quality of evidence was assessed using Modified Newcastle-Ottawa Scoring, with the majority of studies scoring medium or high quality. The mean success rate was 95.4% (confidence interval 91.0%-99.3%), over a wide age range. There was a noticeable heterogeneity in reported follow-up length and definitions of success rate. The majority of studies reported length of stay of ∼1 day. The mean overall complication rate was 12%. For studies that reported complication rate by grade, the mean low Clavien grade (Grade 2 or less) complication rate was 9.3% and the mean high Clavien grade (Grade 3 or more) complication rate was 6.5%. Robot-assisted surgery is technically feasible and has been shown to achieve very favorable outcomes for pyeloplasty in children. The evidence, however, is mostly retrospective and from single sites, which introduces potential biases. Further research is needed to further elucidate RALP benefits compared with the open and laparoscopic approach. As a randomized control trial may not be practical in this space, perhaps a prospective multi-institutional design with a uniform reporting system of pediatric RALP is the next step to define its benefits and limits.
