Single-port robotic extraperitoneal pediatric pyeloplasty using low anterior access: Description of technique and initial experience

Introduction We aim to report our surgical technique, functional and radiological outcomes of single port (SP) extraperitoneal robotic pediatric pyeloplasty through a low anterior (3cm) access using a da-Vinci single-port (SP) robotic surgical system in the pediatric population. Material and methods We present our initial series of 6 pediatric patients that underwent robotic SP extraperitoneal pyeloplasty between 2022 - 2023. Patient clinicopathologic variables and perioperative outcomes were collected prospectively. Results All cases of SP extraperitoneal pyeloplasty were completed without any intraoperative complications or conversion to an open, laparoscopic, or multi-port robotic pyeloplasty. Total operative times including cystoscopy ranged from 178 mins to 240 mins. All patients tolerated the surgery with minimal postsurgical pain and no narcotic requirement. No intraoperative or immediate postoperative complications were recorded in the cohort. There were no readmissions after discharge at a median follow-up of 12 months (6-18 months) in our series. Conclusions Single port extraperitoneal pyeloplasty is a safe and feasible option for upper tract reconstruction in pediatric patients. All patients had complete resolution of symptoms and improvement of hydronephrosis on follow-up imaging.