title: Robot assisted pyeloplasty in the infant-lessons learned.
abstract: OBJECTIVE
  Robot assisted pyeloplasty is emerging as an effective tool for treatment of ureteropelvic junction obstruction in the pediatric population. However, access needed for the procedure is difficult in the small abdominal cavity of an infant. We present our experience with infant robot assisted pyeloplasty, along with some lessons learned that render this procedure possible in these small patients.
  
  
  METHODS
  Nine children 3 to 8 months old (mean 5.6) underwent transperitoneal robot assisted pyeloplasty for ureteropelvic junction obstruction using the da Vinci Surgical System. All patients underwent Anderson-Hynes dismembered pyeloplasty without renal pelvis tapering. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography and/or diuretic radionuclide imaging.
  
  
  RESULTS
  All infants successfully underwent robot assisted laparoscopic pyeloplasty without conversion to pure laparoscopy or open procedure. Mean operative time was 122.8 minutes, with a mean console time of 72.1 minutes. Mean hospital stay was 1.4 days. Of the 9 patients 7 (78%) had resolution of or improvement in hydronephrosis, while 2 had no evidence of obstruction based on followup diuretic renography.
  
  
  CONCLUSIONS
  Robot assisted pyeloplasty is a safe and effective option in the surgical treatment of infant ureteropelvic junction obstruction. Further long-term studies are needed to confirm the usefulness of robotics in minimally invasive pediatric surgery.
authors.affiliation: Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyen
authors.forename: Thomas
authors.initials: T
authors.lastname: Guzzo
authors.forename: Daniel
authors.initials: D
authors.lastname: Canter
authors.forename: Pasquale
authors.initials: P
authors.lastname: Casale
mesh_terms: D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D014517:Ureteral Obstruction / Q000601:surgery*