Open versus robot-assisted laparoscopic pyeloplasty in children: our preliminary experience

Abstract Introduction Robotic surgery has been performed in pediatric patients at our center since early 2022. The aim of this study is to analyze the feasibility and safety of robot-assisted laparoscopic pyeloplasty (RALP) by comparing it with the open surgical technique. Materials and methods We retrospectively analyzed data from patients who underwent pyeloplasty at our center between February 2022 and December 2024. Collected variables included patient sex, age and weight at the time of surgery, operative time, length of hospital stay and complication rate. Patients were divided into two groups: Group O (open pyeloplasty) and Group R (RALP). Results A total of 25 patients underwent pyeloplasty during the study period—13 via the open approach (Group O) and 12 via the robot-assisted approach (Group R). The statistical models, adjusted for patient sex, showed the following significant differences: Group O had a lower estimated mean age of 1.1 years (95% CI 10 months–1.4 years) compared with 12.1 years (95% CI 10.6–13.1 years) in Group R; a lower estimated mean operative time (3.05 h; 95% CI 2.81–3.3) than Group R (3.9 h 95% CI 3.5–4.1); and a lower estimated mean weight of 10.7 kg (95% CI 8.3–12.1 kg) compared with 42.8 kg (95% CI 35.1–52.2 kg) in Group R. Average hospital stays were 4 days for Group O and 3 days for Group R. Only one minor complication (Clavien-Dindo Grade I) was recorded, in Group O. Discussion and conclusions Despite a longer operative time for RALP, the outcomes are comparable—and potentially superior—to those of open surgery. RALP was associated with a shorter hospital stay, potentially reducing overall costs. No complications were observed in the RALP group. These preliminary results suggest that RALP is a safe and feasible option for pediatric patients.