Shifting Gears in Pediatric Pyeloplasty: A Systematic Review and Meta-Analysis of Robotic vs Conventional Laparoscopic Approaches for Ureteropelvic Junction Obstruction

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Published: Aug 30, 2026
DOI: https://doi.org/10.63918/fhr.v3.n2.p1-11.2026
Keywords:
robot-assisted, laparoscopy, ureteropelvic junction obstruction, pyeloplasty, children

Main Article Content

Annisa Ulfa
Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia
https://orcid.org/0009-0009-3917-6007
Gabriel Tandecxi
Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia
Prayoga Eko Nuryadi
Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia
Cika Joyita Patria
Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia

Abstract

Background: Ureteropelvic junction obstruction (UPJO) obstructs the flow of urine and can damage the kidney when it is left untreated. Open pyeloplasty (OP) is still the gold standard, yet laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) achieve comparable success rates. This study aimed to evaluate the efficacy and safety of RALP compared with LP in pediatric patients.


Methods: A meta-analysis was conducted on studies published after 2010 that were identified from multiple databases. Comparative studies, including randomized controlled trials (RCTs) and non-RCTs (retrospective cohort and retrospective studies), were included. The primary outcomes were operative success rate, operative time, length of hospital stay, intraoperative blood loss, UPJO recurrence, and complications. The analysis was performed in accordance with the PRISMA guidelines.


Results: Sixteen studies (15 cohort studies and 1 RCT) involving 4,707 patients, with an overall moderate risk of bias, were included. RALP significantly increased the success rate by 2% (p = 0.03) and reduced the length of hospital stay by 1.71 days (p < 0.0001) compared with LP. In addition, RALP significantly reduced intraoperative blood loss by 4.63 mL (p = 0.04) and postoperative complications by 42% (p = 0.02). No significant differences were observed in operative time or UPJO recurrence between the two groups.


Conclusion: RALP provided significant advantages over LP in pediatric UPJO, particularly in reducing hospital stay, blood loss, and complications, which supports its use as a safe and effective alternative wherever robotic facilities are available.

Article Details

How to Cite
1.
Ulfa A, Tandecxi G, Eko Nuryadi P, Joyita Patria C. Shifting Gears in Pediatric Pyeloplasty: A Systematic Review and Meta-Analysis of Robotic vs Conventional Laparoscopic Approaches for Ureteropelvic Junction Obstruction. Front. Healthc. Res. [Internet]. 2026 Aug. 30 [cited 2026 Sep. 1];3(2):1-11. Available from: https://frontiersonhealthcare.org/index.php/id/article/view/115
Issue
Vol. 3 No. 2 (2026)
Section
Article
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This work is licensed under a Creative Commons Attribution 4.0 International License.

Author Biographies

Annisa Ulfa, Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia

My name is Annisa’ Ulfa, and usually called caul. I was born in Bengkalis, August, 12th 1998. Currently, I live in Pekanbaru, Riau Province, I am an alumnus of the faculty of medicine, Riau University in 2016 and become a general practitioner in 2022. I am currently a general practitioner who Is undergoing a pediatric surgery internship at general hospital Arifin Achmad, Pekanbaru, Riau Province. I have an interest in the field of pediatric surgery so I hope I can contribute to the publication of research in the field of pediatric surgery.

Gabriel Tandecxi, Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia

an alumnus of the Faculty of Medicine and Health Sciences Atma Jaya Indonesian Catholic University and currently live in Dumai, Riau Province as a general practitioner.

Prayoga Eko Nuryadi, Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia

A general practitioner in Prayoga clinic at Lintas Selatan, Talang Mulya, Batang cenaku, Indragili Hulu, Riau Province

Cika Joyita Patria, Tengku Rafian General Hospital, Siak Regency, Riau, Indonesia

a fresh graduate doctor who lived in Padang, West Sumatera.

How to Cite

1.
Ulfa A, Tandecxi G, Eko Nuryadi P, Joyita Patria C. Shifting Gears in Pediatric Pyeloplasty: A Systematic Review and Meta-Analysis of Robotic vs Conventional Laparoscopic Approaches for Ureteropelvic Junction Obstruction. Front. Healthc. Res. [Internet]. 2026 Aug. 30 [cited 2026 Sep. 1];3(2):1-11. Available from: https://frontiersonhealthcare.org/index.php/id/article/view/115

References

Ferlini CM, Fusi G, Marinaro M, Gazzaneo M, Mencherini S, Raffaele A, et al. Robotic versus laparoscopic technique for ureteropelvic junction obstruction treatment in children: a comparative study. J Laparoendosc Adv Surg Tech A. 2026;36(1):65-72.

Kumar G, Weinstein I, Stern J, Badreldin AM, et al. Ureteropelvic junction obstruction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026.

Lukkanawong N, Honda M, Teraoka S, Iwamoto H, Morizane S, Hikita K, et al. A comparison between laparoscopic and robot-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Yonago Acta Med. 2022;65(2):126-31.

Fernandez N, Farhat W. A comprehensive analysis of robot-assisted surgery uptake in the pediatric surgical discipline. Front Surg. 2019;6:9.

Silay MS, Danacioglu O, Ozel K, Karaman MI, Caskurlu T. Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial. World J Urol. 2020;38(8):1841-8.

Sun L, Zhao D, Shen Y, Tang D, Chen G, Zhu L, et al. Laparoscopic versus robot-assisted pyeloplasty in infants and young children. Asian J Surg. 2023;46(2):868-73.

Patel A, Pickhardt MW, Littlejohn N, Zamilpa I, Rettiganti M, Luo C, et al. Shortened operative time for pediatric robotic versus laparoscopic dismembered pyeloplasty. Can J Urol. 2016;23(3):8308-11.

Esposito C, Masieri L, Castagnetti M, Sforza S, Farina A, Cerulo M, et al. Robot-assisted vs laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO): technical considerations and results. J Pediatr Urol. 2019;15(6):667-8.

Chen J, Xu H, Lin S, He S, Tang K, Xiao Z, et al. Robot-assisted pyeloplasty and laparoscopic pyeloplasty in children: a comparison of single-port-plus-one and multiport surgery. Front Pediatr. 2022;10:957790.

Ganpule A, Jairath A, Singh A, Mishra S, Sabnis R, Desai M. Robotic versus conventional laparoscopic pyeloplasty in children less than 20 kg by weight: single-center experience. World J Urol. 2015;33(11):1867-73.

Neheman A, Kord E, Zisman A, Darawsha AE, Noh PH. Comparison of robotic pyeloplasty and standard laparoscopic pyeloplasty in infants: a bi-institutional study. J Laparoendosc Adv Surg Tech A. 2018;28(4):467-70.

Pérez-Marchán M, Pérez-Brayfield M. Comparison of laparoscopic pyeloplasty vs. robot-assisted pyeloplasty for the management of ureteropelvic junction obstruction in children. Front Pediatr. 2022;10:1038454.

Liu DB, Ellimoottil C, Flum AS, Casey JT, Gong EM. Contemporary national comparison of open, laparoscopic, and robotic-assisted laparoscopic pediatric pyeloplasty. J Pediatr Urol. 2014;10(4):610-5.

Andolfi C, Lombardo AM, Aizen J, Recabal X, Walker JP, Barashi NS, et al. Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutional comparison of outcomes and learning curves. World J Urol. 2022;40(4):1049-56.

Varda BK, Johnson EK, Clark C, Chung BI, Nelson CP, Chang SL. National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. J Urol. 2014;191(4):1090-6.

Song SH, Lee C, Jung J, Kim SJ, Park S, Park H, et al. Comparative study of pediatric open pyeloplasty, laparoscopy-assisted extracorporeal pyeloplasty, and robot-assisted laparoscopic pyeloplasty. PLoS One. 2017;12(4):e0175026.

Li J, Chen J, Jia J, He S, Xu D. Comparison of robotic assisted single incision plus one port laparoscopic pyeloplasty and single incision laparoscopic pyeloplasty in the treatment of pediatric ureteropelvic junction obstruction. Natl Med J China. 2024;104(5):371-6.

González ST, Rosito TE, Tur AB, Ruiz J, Gozalbez R, Maiolo A, et al. Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO). Int Braz J Urol. 2022;48(6):961-8.

Chan YY, Durbin-Johnson B, Sturm RM, Kurzrock EA. Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions. J Pediatr Urol. 2017;13(1):49.e1-49.e6.

Cobellis G, Bindi E. Pyeloplasty in children with ureteropelvic junction obstruction and associated kidney anomalies: can a robotic approach make surgery easier? Children. 2023;10(9):1448.