Efficacy and safety of robotic laparoscopic surgery in the treatment of ureteropelvic junction obstruction in pediatric patients: a systematic review

Pediatric ureteropelvic junction obstruction (UPJO) has been replaced by robotic-assisted laparoscopic pyeloplasty (RALP) more and more frequently as compared to open and conventional laparoscopic procedures. This method is desirable as it leads to increased dexterity and visualization, but the method is constrained by cost, learning and lack of long-term consistency. The paper is a systematic review that summarizes the data regarding the effectiveness and safety of RALP in the child population. A detailed search of PubMed, Cochrane, Embase and Scopus (20002025) found 20 eligible studies including randomized controlled trials, prospective cohort and retrospective series. The inclusion criteria included patients aged less than 18 years who had undergone RALP to treat UPJO and have recorded successful outcomes. Information that was extracted included operative time, success, complications and hospital stay. The tools of quality assessment were RoB 2, ROBINS-I, NIH and AMSTAR-2. Synthesis of pooled data were done using random effects model. Across 1,420 pediatric cases, pooled success was 95.2% (range 92.6-100) with an overall complication rate of 8.5%, of which 2.1% were major (Clavien-Dindo ≥III). Mean operative time averaged 110 minutes for RALP versus 144 minutes for conventional laparoscopy, while hospital stay was comparable or shorter for RALP (1.8 vs 3.5 days vs open). Infants and complex UPJO cases demonstrated similar outcomes with slightly longer operative times. RALP achieves high success and low complication rates in pediatric UPJO, outperforming conventional laparoscopy in efficiency and postoperative recovery but heterogeneity, short follow-up and limited cost-effectiveness data temper definitive conclusions. Multi-institutional randomized trials with standardized outcome definitions remain essential to confirm long-term renal benefits and economic feasibility.