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Current Urology Reports
Published in: Current Urology Reports 3/2024

07-02-2024 | Pyeloplasty

Pediatric Robot-Assisted Laparoscopic Pyeloplasty: Where Are We Now?

Authors: Suhaib Abdulfattah, Sameer Mittal

Published in: Current Urology Reports | Issue 3/2024

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Abstract

Purpose of Review

This review aims to provide an in-depth exploration of the recent advancements in robot-assisted laparoscopic pyeloplasty (RALP) and its evolving landscape in the context of infant pyeloplasty, complex genitourinary (GU) anatomy, recurrent ureteropelvic junction (UPJ) obstruction, cost considerations, and the learning curve.

Recent Findings

Recent literature highlights the safety and efficacy of RALP in treating the infant population, patients with complex GU anomalies, and recurrent UPJO which were all traditionally managed using the open approach. Cost considerations are evolving, with the potential for RALP to have a lesser financial burden. In addition, the learning curve for RALP is diminishing due to robust training programs and advances in research.

Summary

RALP has become the gold standard in the treatment of UPJO in pediatric urology at many children’s hospitals. Surgeon comfort and research in this space allow safe and successful reconstruction in the most challenging of cases.
Literature
1.
2.
•• Esposito C, Cerulo M, Lepore B, Coppola V, D’Auria D, Esposito G, Carulli R, Del Conte F, Escolino M. Robotic-assisted pyeloplasty in children: a systematic review of the literature. J Robot Surg. 2023:1-8. Systematic review discussing controversial topics of pediatric RALP and its evolution throughout time.
3.
Morales-López RA, Pérez-Marchán M, Pérez Brayfield M. Current concepts in pediatric robotic assisted pyeloplasty. Front Pediatr. 2019;7:4.
4.
Park JM, Bloom DA. The pathophysiology of UPJ obstruction. Current concepts Urol Clin North Am. 1998;25(2):161–9.CrossRefPubMed
5.
Silay MS, Spinoit AF, Undre S, Fiala V, Tandogdu Z, Garmanova T, Guttilla A, Sancaktutar AA, Haid B, Waldert M, Goyal A. Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party. J Pediatric Urol. 2016;12(4):229-e1.
6.
Chan YY, Durbin-Johnson B, Sturm RM, Kurzrock EA. Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions. J Pediatric Urol. 2017;13(1):49-e1.
7.
Tomaszewski JJ, et al. Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol. 2012;26(6):602–13.CrossRefPubMed
8.
Anderson JC, Hynes W. Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol. 1949;21(3):209–14.CrossRefPubMed
9.
Kawal T, Srinivasan AK, Shrivastava D, Chu DI, Van Batavia J, Weiss D, Long C, Shukla AR. Pediatric robotic-assisted laparoscopic pyeloplasty: does age matter?. J Pediatric Urol. 2018;14(6):540-e1.
10.
11.
12.
Peters CA. Robotically assisted surgery in pediatric urology. Urol Clin North Am. 2004;31(4):743–52.CrossRefPubMed
13.
Muneer A, et al. Current status of robotic surgery in pediatric urology. Pediatr Surg Int. 2008;24(9):973–7.CrossRefPubMed
14.
15.
Kawal T, Srinivasan AK, Shrivastava D, Chu DI, Van Batavia J, Weiss D, Long C, Shukla AR. Pediatric robotic-assisted laparoscopic pyeloplasty: does age matter. J Pediatric Urol. 2018;14(6):540-e1.
16.
Masieri L, Sforza S, Grosso AA, Cini C, Viola L, Tellini R, Mari A, Di Maida F, Minervini A, Carini M. Does the body weight influence the outcome in children treated with robotic pyeloplasty. J Pediatric Urol. 2020;16(1):109-e1.
17.
Ganpule A, et al. Robotic versus conventional laparoscopic pyeloplasty in children less than 20 kg by weight: single-center experience. World J Urol. 2015;33(11):1867–73.CrossRefPubMed
18.
Ballouhey Q, Villemagne T, Cros J, Szwarc C, Braik K, Longis B, Lardy H, Fourcade L. A comparison of robotic surgery in children weighing above and below 15.0 kg: size does not affect surgery success. Surg Endosc. 2015;29:2643-50.
19.
Baek M, Silay MS, Au JK, Huang GO, Elizondo RA, Puttmann KT, Janzen NK, Seth A, Roth DR, Koh CJ. Does the use of 5 mm instruments affect the outcomes of robot-assisted laparoscopic pyeloplasty in smaller working spaces? A comparative analysis of infants and older children. J Pediatric Urol. 2018;14(6):537-e1.
20.
Neheman A, et al. Comparison of robotic pyeloplasty and standard laparoscopic pyeloplasty in infants: a bi-institutional study. J Laparoendosc Adv Surg Tech A. 2018;28(4):467–70.CrossRefPubMed
21.
Avery DI, Herbst KW, Lendvay TS, Noh PH, Dangle P, Gundeti MS, Steele MC, Corbett ST, Peters CA, Kim C. Robot-assisted laparoscopic pyeloplasty: multi-institutional experience in infants. J Pediatric Urol. 2015;11(3):139-e1.
22.
Kutikov A, Nguyen M, Guzzo T, Canter D, Casale P. Robot assisted pyeloplasty in the infant—lessons learned. J Urol. 2006;176(5):2237-40.
23.
Bansal D, et al. Infant robotic pyeloplasty: comparison with an open cohort. J Pediatr Urol. 2014;10(2):380–5.CrossRefPubMed
24.
•• Esposito C, Masieri L, Blanc T, Musleh L, Ballouhey Q, Fourcade L, Escolino M. Robot-assisted laparoscopic pyeloplasty (RALP) in children with complex pelvi-ureteric junction obstruction (PUJO): results of a multicenter European report. World J Urol. 2021;39:1641-7. Multi-institutional study comparing outcomes of RALP in patients with complex anatomy.
25.
Esposito C, et al. Robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidneys: results of a multicentric study. World J Urol. 2019;37(10):2257–63.CrossRefPubMed
26.
Bowen DK, Mittal S, Aghababian A, Eftekharzadeh S, Dinardo L, Weaver J, Long C, Shukla A, Srinivasan AK. Pyeloplasty is a safe and effective surgical approach for low functioning kidneys with ureteropelvic junction obstruction. J Pedia Urol. 2021;17(2):233-e1.
27.
Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol. 1990;144(2):584-7.
28.
Bansal R, et al. Long-term results of pyeloplasty in poorly functioning kidneys in the pediatric age group. J Pediatr Urol. 2012;8(1):25–8.MathSciNetCrossRefPubMed
29.
Nayyar R, et al. Outcomes of pyeloplasty in very poorly functioning kidneys: examining the myths. Urology. 2016;92:132–5.CrossRefPubMed
30.
Sarhan O, Al Otay A, Al Faddagh A, El Helaly A, Al Hagbani M, Al Ghanbar M, Al Kawai F, Nakshabandi Z. Pyeloplasty in children with low differential renal function: functional recoverability. J Pedia Urol. 2021;17(5):658-e1.
31.
32.
Ebert KM, Nicassio L, Alpert SA, Ching CB, Dajusta DG, Fuchs ME, McLeod DJ, Jayanthi VR. Surgical outcomes are equivalent after pure laparoscopic and robotic-assisted pyeloplasty for ureteropelvic junction obstruction. J Pedia Urol. 2020;16(6):845-e1.
33.
Davis TD, Burns AS, Corbett ST, Peters CA. Reoperative robotic pyeloplasty in children. J Pedia Urol. 2016 Dec 1;12(6):394-e1.
34.
•• Mittal S, Aghababian A, Eftekharzadeh S, Dinardo L, Weaver J, Weiss DA, Long C, Srinivasan AK, Shukla AR. Primary vs redo robotic pyeloplasty: A comparison of outcomes. J Pedia Urol. 2021;17(4):528-e1. Largest comparative study between primary and redo-pyeloplasty.
35.
Jacobson DL, et al. Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: an updated series. J Urol. 2019;201(5):1005–11.CrossRefPubMed
36.
Baek M, et al. Quantifying the additional difficulty of pediatric robot-assisted laparoscopic re-do pyeloplasty: a comparison of primary and re-do procedures. J Laparoendosc Adv Surg Tech A. 2018;28(5):610–6.CrossRefPubMed
37.
Chandrasekharam VVS, Babu R. A systematic review and metaanalysis of open, conventional laparoscopic and robot-assisted laparoscopic techniques for re-do pyeloplasty for recurrent uretero pelvic junction obstruction in children. J Pediatr Urol. 2022;18(5):642–9.CrossRefPubMed
38.
Esposito C, et al. Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty. Int Urol Nephrol. 2022;54(10):2503–9.CrossRefPubMedPubMedCentral
39.
Mittal S, et al. Robot-assisted laparoscopic ureterocalicostomy in the setting of ureteropelvic junction obstruction: a multi-institutional cohort. J Urol. 2022;208(1):180–5.CrossRefPubMed
40.
41.
•• Bodar YJ, Srinivasan AK, Shah AS, Kawal T, Shukla AR. Time-Driven activity-based costing identifies opportunities for process efficiency and cost optimization for robot-assisted laparoscopic pyeloplasty. J Pediatr Urol. 2020 Aug 1;16(4):460-e1., 2020. First paper looking at TDABC in RALP.
42.
Mittal S, Srinivasan A. Robotics in pediatric urology: evolution and the future. Urol Clin North Am. 2021;48(1):113–25.CrossRefPubMed
43.
Bowen DK, et al. Can proctoring affect the learning curve of robotic-assisted laparoscopic pyeloplasty? Experience at a high-volume pediatric robotic surgery center. J Robot Surg. 2017;11(1):63–7.CrossRefPubMed
44.
Pakkasjärvi N, Krishnan N, Ripatti L, Anand S. Learning Curves in Pediatric Robot-Assisted Pyeloplasty: A Systematic Review. J Clin Med. 2022;11(23):6935.
45.
Pio L, et al. Learning curve for robotic surgery in children: a systematic review of outcomes and fellowship programs. J Robot Surg. 2020;14(4):531–41.CrossRefPubMed
46.
47.
Larcher A, et al. The ERUS curriculum for robot-assisted partial nephrectomy: structure definition and pilot clinical validation. Eur Urol. 2019;75(6):1023–31.CrossRefPubMed
48.
Larcher A, et al. Virtual reality validation of the ERUS simulation-based training programmes: results from a high-volume training centre for robot-assisted surgery. Eur Urol. 2019;75(5):885–7.CrossRefPubMed
49.
Metadata
Title
Pediatric Robot-Assisted Laparoscopic Pyeloplasty: Where Are We Now?
Authors
Suhaib Abdulfattah
Sameer Mittal
Publication date
07-02-2024
Publisher
Springer US
Published in
Current Urology Reports / Issue 3/2024
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-024-01195-8