Vol.:(0123456789) 1 3 Pediatr Surg Int DOI 10.1007/s00383-017-4082-7 REVIEW ARTICLE Robot-assisted laparoscopic pyeloplasty in the pediatric population: a review of technique, outcomes, complications, and special considerations in infants William R. Boysen 1  · Mohan S. Gundeti 1   Accepted: 15 March 2017 © Springer-Verlag Berlin Heidelberg 2017 Introduction Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly that is present in approximately 1:2000 live births. The majority of cases in the modern era are detected on routine antenatal ultrasound, though UPJO can less commonly present in older children and adults expe- riencing abdominal pain, nausea, and emesis [1]. The eti- ology of obstruction is most commonly intrinsic fbrosis and narrowing of the ureteropelvic junction, though an insertion anomaly of the ureter or an aberrant crossing ves- sel can also cause obstruction [2, 3]. While there is debate regarding the appropriate timing of surgical intervention, the indications to intervene include worsening split renal function, worsening hydronephrosis with thinning of renal parenchyma, urinary tract infections/pyelonephritis, pain, and nephrolithiasis [4]. The gold standard intervention for UPJO is the Anderson Hynes dismembered pyeloplasty, traditionally performed with an open fank approach. Endoscopic options includ- ing endopyelotomy and retrograde balloon dilation are less invasive, but not routinely used due to suboptimal out- comes relative to pyeloplasty [5]. Laparoscopic pyeloplasty was frst described in 1995 [6] and subsequently shown to be a safe and efective minimally invasive treatment option for UPJO [7]. However, conventional laparoscopy has a signifcant learning curve relative to robot-assisted laparos- copy [8] and is technically challenging for many surgeons. Since its inception, conventional laparoscopic pyeloplasty (CLP) has only been performed by select experts and utili- zation has remained unchanged over time [9]. The robotic platform enhances the laparoscopic approach by provid- ing the surgeon with high resolution three-dimensional visualization and enhanced dexterity with EndoWrist® instrumentation (Intuitive Surgical, Sunnyvale, CA). This Abstract Ureteropelvic junction obstruction is a com- mon condition encountered by the pediatric urologist, and treated with pyeloplasty when indicated. Recent technolog- ical advancements and a shift across all surgical felds to embrace minimally invasive surgery have led to increased utilization of minimally invasive pyeloplasty. Conven- tional laparoscopy is a reasonable choice, but its use is limited by the technical challenges of precise suturing in a confned space and the associated considerable learning curve. Robotic technology has simplifed the minimally invasive approach to pyeloplasty, ofering enhanced visu- alization and improved dexterity with a fairly short learn- ing curve. As utilization of robotic pyeloplasty continues to increase, we sought to critically assess the literature on this approach. We begin with a review of the technical aspects of robot-assisted laparoscopic pyeloplasty including tips for surgical profciency and patient safety. Outcomes and com- plications from the contemporary literature are reviewed, as well as special considerations in the pediatric population including infant pyeloplasty, cost concerns, training, and postoperative diversion/drainage. Keywords Ureteropelvic junction obstruction · Pediatric urology · Minimally invasive surgery · Robotic surgery * Mohan S. Gundeti mgundeti@surgery.bsd.uchicago.edu 1 Pediatric Urology, Comer Children’s Hospital, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, P-217, MC 7122, Chicago, IL 60637, USA