Transperitoneal and retroperitoneal robot-assisted urology in infants ≤ 10 kg: A FRUCT multi-centre study

Robot-assisted surgery is now established in pediatric urology; however, data on indications and morbidity in children weighing less than 10 kg remain limited. This study evaluates the feasibility and outcomes of robotic surgery in infants.

A retrospective analysis of prospectively collected multicentric data was performed over nine years (2015-2024) including infants weighing less than 10 kg who underwent robot-assisted urological surgery. Demographic data, perioperative characteristics, and complications were collected from seven university hospitals.

83 infants were included, with a median age at surgery of 12 months (IQR: 8-16) and a median weight of 9 kg (IQR: 8-10). The main procedures were pyeloplasty (n = 37, 44 %), nephrectomy (upper pole or total, n = 20, 24 %), and adrenalectomy (n = 14, 17 %). Twenty-one procedures (25 %) were performed using a retroperitoneal approach. There were three conversions to open surgery: two during Wilms tumor surgery and one during bilateral adrenalectomy. The median hospital stay was 2 days (IQR: 1-3). Regarding 30-day morbidity, 10 infants (12 %) experienced complications (Grade II Clavien-Dindo), including febrile UTI (5 cases), stent displacement following pyeloplasty (3 cases), and transient urinary retention after bilateral ureteral reimplantation (2 cases). Additional complications observed beyond 30 days included two urinary tract infections (Grade II), one recurrence of hydrocolpos requiring reoperation (Grade IIIb), and one recurrence of ureteropelvic junction obstruction requiring reoperation (Grade IIIb). Median follow-up was 25 months (IQR: 11-66).

This study demonstrates that robot-assisted urological surgery is feasible and safe in infants as young as three months of age. The reduced workspace does not appear to limit this surgical approach, whether via transperitoneal or retroperitoneal approach.