Laparoscopy in pediatric urology: from inception to innovation - a comprehensive review

Laparoscopic urology has marked a significant advancement in pediatric surgery, offering less invasive procedures and improved postoperative outcomes. Initially utilized for diagnosing cryptorchidism in 1976, its therapeutic applications expanded in the 1990s to include surgeries such as orchiopexy, nephrectomy, pyeloplasty, etc. Laparoscopy, as a minimally invasive technique, allows visualization and treatment of abdominal and pelvic organs. The therapeutic potential of laparoscopy emerged in the 1990s, when Clayman and colleagues performed the first laparoscopic nephrectomy, marking the start of therapeutic laparoscopy. Since then, it has evolved significantly, becoming a standard approach in many pediatric urology centers. Technological advancements, particularly the development of miniature equipment and robotic-assisted surgery, have transformed pediatric laparoscopy, making it feasible even for neonates and infants. However, challenges persist, including increased expenses, a steep learning curve, and the need for compelling evidence before newer technologies are widely implemented. Future directions include improving telemedicine support, investigating pediatric-specific procedures, and integrating novelties such as single-site laparoscopy and natural orifice transluminal endoscopic surgery. While laparoscopic techniques have significantly advanced, further research is required to assess long-term results, cost-effectiveness, and the psychological impact on children. This narrative review highlights the revolutionary impact of laparoscopy on pediatric urology, emphasizing the need for ongoing research, training, and global collaboration to optimize outcomes and ensure wider accessibility. By addressing these challenges and refining new technologies, the future of laparoscopy in pediatric urology appears promising, with the potential to significantly improve the lives of young patients with urological conditions.