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Comparative Outcomes of Robot-Assisted and Laparoscopic Pyeloplasty in Infants and Toddlers: A Systematic Review and
Maciej Szyduczyński1, Johannes Korneliussen2, Adrianna Jażdżewska2
1Department of Surgery and Urology for Children and Adolescents, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland.
Insights
Robot-assisted laparoscopic pyeloplasty (RALP) offers shorter hospital stays than traditional laparoscopic pyeloplasty (LP) for infants with ureteropelvic junction obstruction (UPJO). Both minimally invasive techniques show similar safety and success rates.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Congenital Anomalies
Background:
- Ureteropelvic junction obstruction (UPJO) is a frequent congenital anomaly in young children.
- Laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) are established minimally invasive treatments.
- Comparative outcomes of RALP versus LP in children under 3 years old are not well-defined.
Purpose of the Study:
- To evaluate the safety and efficacy of RALP compared to LP.
- Focus on infants and children younger than 3 years or weighing less than 15 kg.
Main Methods:
- Systematic literature search of PubMed, Web of Science, and Embase up to May 2025.
- Included five retrospective cohort studies with 272 patients meeting specific age/weight criteria.
- Meta-analysis conducted using random-effects models.
Main Results:
- RALP group demonstrated a significantly shorter hospital stay (mean difference: -1.69 days).
- No significant differences were found in operative time between RALP and LP.
- Comparable complication and success rates were observed for both surgical approaches.
Conclusions:
- RALP is associated with reduced hospitalization time compared to LP in young children.
- RALP maintains comparable safety and efficacy profiles to LP.
- RALP is a valuable minimally invasive option for UPJO in this pediatric population, warranting further prospective studies.
Abstract:
Background: Ureteropelvic junction obstruction (UPJO) represents a common congenital anomaly in infants and young children. While minimally invasive approaches, including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), have gained acceptance, comparative outcomes in children younger than 3 years have still not been well-established. This study aimed to evaluate the safety and efficacy of RALP versus LP in infants and children younger than 3 years or weighing < 15 kg. Methods: A systematic literature search of PubMed, Web of Science, and Embase was conducted through May 2025. Five retrospective cohort studies comprising 272 patients met inclusion criteria (age younger than 3 years or weighing < 15 kg). Meta-analysis was performed using random-effects models. Results: Hospital stay was significantly shorter in the RALP group compared with LP (mean difference = -1.69 days; 95% CI: -2.71 to -0.67). No statistically significant differences were observed in operative time, complication rates, or success rates between approaches. Conclusions: RALP is associated with significantly reduced hospitalization time compared with LP in infants and young children, while maintaining comparable safety and efficacy profiles. These findings support RALP as a valuable minimally invasive option in this challenging patient population, though larger prospective studies are warranted.
