ADVANCES IN MINIMALLY INVASIVE SURGERY FOR THE MANAGEMENT OF UPPER URINARY TRACT ANOMALIES IN CHILDREN

Julia Załęcka; Katarzyna Moliszewska; Paweł Kukiełka; Joanna Kośka; Gabriela Łocik; Julia Mazurek; Alicja Nowik; Kacper Dywan; Martyna Musiorska; Michał Błaszkiewicz; Julia Żak

doi:10.31435/ijitss.3(47).2025.3625

Julia Załęcka Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0000-0003-3851-3066
Katarzyna Moliszewska Independent Public Central Clinical Hospital in Warsaw, ul. Banacha 1A, 02-097 Warsaw, Poland https://orcid.org/0009-0009-5459-4338
Paweł Kukiełka State Medical Institute of the Ministry of the Interior and Administration in Warsaw, Wołoska 137, 02-507 Warsaw, Poland https://orcid.org/0009-0007-0303-6999
Joanna Kośka Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0003-5971-6222
Gabriela Łocik Wolski Hospital named after dr Anna Gostyńska, Marcina Kasprzaka 17, 01-211 Warsaw, Poland https://orcid.org/0009-0000-8111-279X
Julia Mazurek Independent Public Clinical Hospital named after prof. Witold Orłowski CMKP, ul. Czerniakowska 231, 00-416 Warsaw, Poland https://orcid.org/0009-0003-7753-7797
Alicja Nowik Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0004-0446-0116
Kacper Dywan Railway Hospital named after dr med. Włodzimierza Roeflera, Warsztatowa 1, 05-800 Pruszków, Poland https://orcid.org/0009-0006-4551-7902
Martyna Musiorska Central Teaching Hospital of the Medical University of Lodz, Pomorska 251, 92-213 Łódź, Poland https://orcid.org/0009-0000-9773-5449
Michał Błaszkiewicz State Medical Institute of the Ministry of the Interior and Administration in Warsaw, Wołoska 137, 02-507 Warsaw, Poland https://orcid.org/0009-0005-5417-9688
Julia Żak Independent Public Central Clinical Hospital in Warsaw, ul. Banacha 1A, 02-097 Warsaw, Poland https://orcid.org/0009-0008-3383-8025

DOI: https://doi.org/10.31435/ijitss.3(47).2025.3625

Keywords: Minimally Invasive Surgery, Pediatric Urology, Robotic-Assisted Surgery, Laparoscopy, Urinary Tract, Pyeloplasty, Nephrectomy, Ureteroureterostomy, Ureterocalicostomy

Abstract

Background. Minimally invasive surgery (MIS) has significantly evolved in pediatric urology, offering alternatives to traditional open techniques by reducing postoperative morbidity, improving cosmetic outcomes, and accelerating recovery. Technological advancements, especially the miniaturization of instruments and the introduction of robotic systems, have expanded the indications and efficacy of MIS for upper urinary tract anomalies in children.

Aim. To review the current applications, outcomes, and future directions of minimally invasive techniques in the treatment of upper urinary tract anomalies in the pediatric population.

Material and Methods. This narrative review summarizes data from published literature regarding laparoscopic and robot-assisted procedures in pediatric urology. It analyzes indications, technical considerations, benefits, limitations, and comparative outcomes of MIS versus open surgery, focusing on procedures such as pyeloplasty, nephrectomy, ureteroureterostomy, and ureterocalicostomy.

Results. MIS approaches demonstrated reduced hospital stays, less blood loss, lower opioid use, and improved cosmetic results with comparable complication rates to open surgery. Robot-assisted procedures, particularly pyeloplasty, showed promising safety and efficacy—even in infants—and allowed for outpatient, stent-free interventions. Challenges remain in cost, equipment scaling for pediatric patients, and training requirements.

Conclusions. MIS, including robotic-assisted surgery, is becoming the gold standard for many upper urinary tract interventions in children. Continued technological advancement and surgical expertise are expected to further enhance outcomes, expand indications, and improve the quality of care in pediatric urology.

References

Sood, A.; Meyer, C.P.; Abdollah, F.; Sammon, J.D.; Sun, M.; Lipsitz, S.R.; Hollis, M.; Weissman, J.S.; Menon, M.; Trinh, Q.-D. Minimally Invasive Surgery and Its Impact on 30-Day Postoperative Complications, Unplanned Readmissions and Mortality. Br. J. Surg. 2017, 104, 1372–1381, doi:10.1002/bjs.10561.

Gobbi, D.; Midrio, P.; Gamba, P. Instrumentation for Minimally Invasive Surgery in Pediatric Urology. Transl. Pediatr. 2016, 5, 18604–18204, doi:10.21037/tp.2016.10.07.

Hidas, G.; Watts, B.; Khoury, A.E. The Evolving Role of Laparoscopic Surgery in Paediatric Urology. Arab J. Urol. 2012, 10, 74–80, doi:10.1016/j.aju.2011.12.010.

Sheth, K.R.; Batavia, J.P.V.; Bowen, D.K.; Koh, C.J.; Srinivasan, A.K. Minimally Invasive Surgery in Pediatric Urology: Adaptations and New Frontiers. Urol. Clin. 2018, 45, 611–621, doi:10.1016/j.ucl.2018.06.008.

Traxel, E.J.; Minevich, E.A.; Noh, P.H. A Review: The Application of Minimally Invasive Surgery to Pediatric Urology: Upper Urinary Tract Procedures. Urology 2010, 76, 122–133, doi:10.1016/j.urology.2009.11.072.

Barbosa, J.A.B.A.; Barayan, G.; Gridley, C.M.; Sanchez, D.C.J.; Passerotti, C.C.; Houck, C.S.; Nguyen, H.T. Parent and Patient Perceptions of Robotic vs Open Urological Surgery Scars in Children. J. Urol. 2013, 190, 244–250, doi:10.1016/j.juro.2012.12.060.

F, O.; Wa, F.; Ma, K. Cost, Training and Simulation Models for Robotic-Assisted Surgery in Pediatric Urology. World J. Urol. 2020, 38, doi:10.1007/s00345-019-02822-7.

Yeung, C.K.; Thakre, A.A. CHAPTER 7 - LAPAROSCOPY IN PEDIATRIC UROLOGY. In Pediatric Urology (Second Edition); Gearhart, J.P., Rink, R.C., Mouriquand, P.D.E., Eds.; W.B. Saunders: Philadelphia, 2010; pp. 92–107 ISBN 978-1-4160-3204-5.

Rd, N.; Mc, O. Evolution of Laparoscopy in Pediatric Urology. Expert Rev. Med. Devices 2009, 6, doi:10.1586/erd.09.42.

Cortesi, N.; Ferrari, P.; Zambarda, E.; Manenti, A.; Baldini, A.; Morano, F.P. Diagnosis of Bilateral Abdominal Cryptorchidism by Laparoscopy. Endoscopy 1976, 8, 33–34, doi:10.1055/s-0028-1098372.

Lindgren, B.W.; Darby, E.C.; Faiella, L.; Brock, W.A.; Reda, E.F.; Levitt, S.B.; Franco, I. Laparoscopic Orchiopexy: Procedure of Choice for the Nonpalpable Testis? J. Urol. 1998, 159, 2132–2135, doi:10.1016/S0022-5347(01)63294-4.

Baker, L.A.; Docimo, S.G.; Surer, I.; Peters, C.; Cisek, L.; Diamond, D.A.; Caldamone, A.; Koyle, M.; Strand, W.; Moore, R.; et al. A Multi-Institutional Analysis of Laparoscopic Orchidopexy. BJU Int. 2001, 87, 484–489, doi:10.1046/j.1464-410x.2001.00127.x.

Koyle, M.A.; Woo, H.H.; Kavoussi, L.R. Laparoscopic Nephrectomy in the First Year of Life. J. Pediatr. Surg. 1993, 28, 693–695, doi:10.1016/0022-3468(93)90034-i.

El-Ghoneimi, A.; Sauty, L.; Maintenant, J.; Macher, M.A.; Lottmann, H.; Aigrain, Y. Laparoscopic Retroperitoneal Nephrectomy in High Risk Children. J. Urol. 2000, 164, 1076–1079, doi:10.1097/00005392-200009020-00039.

Nascimben, F.; Lachkar, A.; Becmeur, F.; Maldonado, C.; Molinaro, F.; Angotti, R.; Andolfi, C.; Geiss, S.; Talon, I. Minimally Invasive Surgery for Adrenal Masses in Children: Results of a Two European Centers Survey and Literature Review. J. Laparoendosc. Adv. Surg. Tech. A 2025, 35, 170–177, doi:10.1089/lap.2024.0046.

Iwanaka, T.; Arai, M.; Ito, M.; Kawashima, H.; Yamamoto, K.; Hanada, R.; Imaizumi, S. Surgical Treatment for Abdominal Neuroblastoma in the Laparoscopic Era. Surg. Endosc. 2001, 15, 751–754, doi:10.1007/s004640080074.

Gerwinn, T.; Gnannt, R.; Weber, D.M.; Gobet, R.; Mazzone, L. Laparoscopic Ureteroureterostomy vs. Common Sheath Ureteral Reimplantation in Children With Duplex Kidney Anomalies. Front. Pediatr. 2021, 9, 637544, doi:10.3389/fped.2021.637544.

Feng, S.; Yu, Z.; Yang, Y.; Bi, Y.; Luo, J. Minimally Invasive versus Open Ureteral Reimplantation in Children: A Systematic Review and Meta-Analysis. Eur. J. Pediatr. Surg. Off. J. Austrian Assoc. Pediatr. Surg. Al Z. Kinderchir. 2024, 34, 245–252, doi:10.1055/s-0043-1764321.

Ehrlich, R.M.; Gershman, A. Laparoscopic Seromyotomy (Auto-Augmentation) for Non-Neurogenic Neurogenic Bladder in a Child: Initial Case Report. Urology 1993, 42, 175–178, doi:10.1016/0090-4295(93)90642-n.

Lorenzo, A.J.; Cerveira, J.; Farhat, W.A. Pediatric Laparoscopic Ileal Cystoplasty: Complete Intracorporeal Surgical Technique. Urology 2007, 69, 977–981, doi:10.1016/j.urology.2007.02.029.

Cilento Jr, B. g.; Diamond, D. a.; Yeung, C. k.; Manzoni, G.; Poppas, D. p.; Hensle, T. w. Laparoscopically Assisted Ureterocystoplasty. BJU Int. 2003, 91, 525–527, doi:10.1046/j.1464-410X.2003.04125.x.

Harper, L.; Abbo, O.; Prost, S.; Michel, J.L.; Soubirou, J.L.; Sauvat, F. Combined Laparoscopic-Assisted Nephrectomy, Augmentation Ureterocystoplasty and Mitrofanoff Appendicovesicostomy. J. Pediatr. Urol. 2013, 9, e94–e97, doi:10.1016/j.jpurol.2012.10.004.

Retroperitoneoscopic Heminephrectomy. J. Pediatr. Urol. 2018, 14, 196–197, doi:10.1016/j.jpurol.2018.02.010.

Laparoscopic Strategies in Complex Upper Urinary Tract Obstruction. J. Pediatr. Urol. 2024, 20, 305–311, doi:10.1016/j.jpurol.2023.11.004.

Asimakidou, M.; De Win, G.; Cherian, A. Laparoscopy-Assisted Ureterostomy- Technique. J. Pediatr. Urol. 2019, 15, 423–424, doi:10.1016/j.jpurol.2019.05.013.

Adam, A.; Smith, G.H.H. Anderson-Hynes Pyeloplasty: Are We All Really on the Same Page? ANZ J. Surg. 2016, 86, 143–147, doi:10.1111/ans.13114.

Arap, M.A.; Andrade, H.; Torricelli, F.C.M.; Denes, F.T.; Mitre, A.I.; Duarte, R.J.; Srougi, M. Laparoscopic Ureterocalicostomy for Complicated Upper Urinary Tract Obstruction: Mid-Term Follow-Up. Int. Urol. Nephrol. 2014, 46, 865–869, doi:10.1007/s11255-013-0591-z.

Nishimura, Y.; Moriya, K.; Nakamura, M.; Kitta, T.; Kanno, Y.; Chiba, H.; Kon, M.; Shinohara, N. Laparoscopic Ureterocalicostomy for Ureteropelvic Junction Obstruction in a 10-Year-Old Female Patient: A Case Report. BMC Res. Notes 2017, 10, 247, doi:10.1186/s13104-017-2569-x.

Lobo, S.; Mushtaq, I. Laparoscopic Ureterocalicostomy in Children: The Technique and Feasibility. J. Pediatr. Urol. 2018, 14, 358–359, doi:10.1016/j.jpurol.2018.06.012.

Howe, A.; Kozel, Z.; Palmer, L. Robotic Surgery in Pediatric Urology. Asian J. Urol. 2017, 4, 55–67, doi:10.1016/j.ajur.2016.06.002.

Bruns, N.E.; Soldes, O.S.; Ponsky, T.A. Robotic Surgery May Not “Make the Cut” in Pediatrics. Front. Pediatr. 2015, 3, doi:10.3389/fped.2015.00010.

Garcia, I.; Armas, I.A.S. de; Pimpalwar, A. Current Trends in Pediatric Robotic Surgery. Bangladesh J. Endosurgery 2014, 2, 15–28, doi:10.3329/bje.v2i1.19589.

Cundy, T.P.; Harley, S.J.D.; Marcus, H.J.; Hughes-Hallett, A.; Khurana, S. Global Trends in Paediatric Robot-Assisted Urological Surgery: A Bibliometric and Progressive Scholarly Acceptance Analysis. J. Robot. Surg. 2018, 12, 109–115, doi:10.1007/s11701-017-0703-3.

Khoder, W.Y.; Waidelich, R.; Ghamdi, A.M.A.; Schulz, T.; Becker, A.; Stief, C.G. A Prospective Randomised Comparison between the Transperitoneal and Retroperitoneoscopic Approaches for Robotic-Assisted Pyeloplasty in a Single Surgeon, Single Centre Study. J. Robot. Surg. 2018, 12, 131–137, doi:10.1007/s11701-017-0707-z.

Kafka, I.Z.; Kocherov, S.; Jaber, J.; Chertin, B. Pediatric Robotic-Assisted Laparoscopic Pyeloplasty (RALP): Does Weight Matter? Pediatr. Surg. Int. 2019, 35, 391–396, doi:10.1007/s00383-019-04435-y.

Fichtenbaum, E.J.; Strine, A.C.; Concodora, C.W.; Schulte, M.; Noh, P.H. Tubeless Outpatient Robotic Upper Urinary Tract Reconstruction in the Pediatric Population: Short-Term Assessment of Safety. J. Robot. Surg. 2018, 12, 257–260, doi:10.1007/s11701-017-0722-0.

Mizuno, K.; Kojima, Y.; Nishio, H.; Hoshi, S.; Sato, Y.; Hayashi, Y. Robotic Surgery in Pediatric Urology: Current Status. Asian J. Endosc. Surg. 2018, 11, 308–317, doi:10.1111/ases.12653.

Denning, N.-L.; Kallis, M.P.; Prince, J.M. Pediatric Robotic Surgery. Surg. Clin. North Am. 2020, 100, 431–443, doi:10.1016/j.suc.2019.12.004.

Robotic Partial Nephrectomy in the Pediatric Population: Cumulative Experience at a Large Pediatric Hospital. J. Pediatr. Urol. 2022, 18, 538–540, doi:10.1016/j.jpurol.2022.06.029.

Minimally Invasive Partial Nephrectomy versus Open Surgery in Pediatric Patients with Duplex Collecting System: A Systematic Review and Meta-Analysis. J. Pediatr. Urol. 2025, doi:10.1016/j.jpurol.2025.04.001.

ADVANCES IN MINIMALLY INVASIVE SURGERY FOR THE MANAGEMENT OF UPPER URINARY TRACT ANOMALIES IN CHILDREN

Abstract

References

Most read articles by the same author(s)