Laparoscopic Pyeloplasty via Transmesenteric Approach for Pediatric Ureteropelvic Junction Obstruction

With ongoing advances in minimally invasive surgical techniques, laparoscopic pyeloplasty (LP) has become the standard of care for the treatment of pediatric ureteropelvic junction obstruction (UPJO). Numerous studies have demonstrated that, compared with traditional open surgery, laparoscopic surgery offers significant advantages, including reduced postoperative pain, diminished surgical trauma, accelerated recovery, and superior cosmetic outcomes, while achieving success rates comparable to those of open surgery. Among various surgical approaches, the transmesenteric approach represents an innovative route that directly accesses the renal pelvis through the mesenteric window, effectively circumventing the complex step of extensive colonic mobilization required in conventional transperitoneal laparoscopic pyeloplasty. This approach is particularly advantageous for the treatment of left-sided UPJO in children, enabling rapid and precise localization of the hydronephrotic renal pelvis while avoiding excessive colonic mobilization, thereby shortening operative time and reducing intraoperative blood loss. However, laparoscopic suturing and knot-tying techniques remain technically demanding and challenging, with a prolonged learning curve, particularly in pediatric patients with limited intra-abdominal working space, which imposes stringent requirements on the surgeon's laparoscopic proficiency. With the progressive standardization of surgical techniques and the widespread adoption of robotic-assisted surgical systems, robotic-assisted laparoscopic surgery-leveraging three-dimensional visualization and articulating robotic arms with up to seven degrees of freedom-has substantially reduced the difficulty of fine maneuvers such as intracorporeal dissection and suturing. Combining this approach with advanced laparoscopic technology may further improve surgical outcomes for pediatric UPJO and propel the field toward greater precision and minimal invasiveness.