Redo robotic pyeloplasty in pediatric patients: Technical recommendations for a safe and successful procedure

Recurrent UPJ obstruction after pyeloplasty can present at any time during follow up. There is a wide variety of strategies available for its management, that range from endoscopic procedures to ureterocalicostomy. The robotic approach permits excellent visualization of the anatomy and allows for a redo anastomosis to be performed even in a challenging setting. In this video, we present technical strategies to achieve a successful re do robotic pyeloplasty.

Retrospective review of all pediatric patients that underwent redo pyeloplasty between 2012 and 2023. The procedure was performed following a systematic approach. In all cases cystoscopy, retrograde pyelogram and placement of the double J stent were performed at the start of the case. In presence of significant adhesions, proper identification of the anatomy intraoperatively was achieved by location of the ureter first, followed by ascending dissection towards the renal pelvis. Additional ports and strategic traction stitches were often used for better exposure.

During the study period, we successfully performed 15 redo robotic pyeloplasty in pediatric patients. All cases were completed robotically and none required ureterocalicostomy. Mean operative time was 213 min and median length of stay of 1 day, similar to primary pyeloplasty cases. No re-obstructions have been identified in this cohort so far, with a mean follow up time of 28 months and a median of 20 months.

Redo robotic pyeloplasty is a feasible procedure for the management of failed primary pyeloplasty. With small technical adjustments, it offers the advantage of excellent exposure and visualization which is fundamental to understanding the anatomy and the key factors involved in failure of the primary repair. It has minimal morbidity, short hospitalization, and favorable outcomes. It should be strongly considered for pediatric patients with a recurrent obstruction.