Robotic Pyeloplasty: When Is It Chosen in Children and Adults?

No; in robotic surgery every movement is made by the surgeon — the robot only transmits the surgeon's hand movements to small instruments, without tremor.

Guidelines find robotic pyeloplasty's success and complication rates comparable to the open and laparoscopic methods.

• Older children and adolescents: the abdominal cavity is roomy and the robotic arms work comfortably; the closed methods' advantage of shorter stay and less pain is most pronounced in this age group.
• A crossing vessel: the three-dimensional, magnified view makes separating the vessel and rerouting the ureter in front of it easier.
• Redo pyeloplasty: can be preferred at experienced centers because of the ease of fine dissection and suturing in scarred tissue.
• A concurrent stone: removing stones with a flexible nephroscope while the pelvis is open can also be done through the closed route.

• Robotic pyeloplasty is performed in infants under one year old at experienced centers, with perioperative outcomes reported as similar to open surgery; but instrument size and the narrowness of the abdominal cavity are limiting, and a small-incision open approach remains standard at many centers for infants. The answer to "can robotic surgery be done in infants" varies with age, weight, and center experience.

In adult UPJ obstruction, the first-choice options are laparoscopic or robotic pyeloplasty; open surgery is reserved for selected cases.

• Because muscle and fat tissue are thicker in adults, an open incision is larger than in children; the closed methods' advantage in stay and pain is more pronounced in adults. Endoscopic internal incision (endopyelotomy) is an option for a short narrowing, preserved function, and absence of a crossing vessel, but its success rate is lower than pyeloplasty's. In people whose narrowing, repaired in childhood, recurs in adulthood, robotic redo pyeloplasty is a commonly used route; in our practice, Dr. Issı's experience in adult urology allows the same team to carry a patient through the adolescent-to-adult transition and through an adult redo.

The gains and costs of the robotic approach should be weighed together.

• Advantages: three-dimensional magnified view, wrist-articulated instruments, easier suturing, reduced surgeon fatigue; a shorter learning curve than laparoscopy.
• Limits: high cost and limited availability at every center; instrument size (a tight space in infants); total operating time can lengthen because of robot setup; absence of tactile feedback.

• In terms of success rate, the robotic approach is not superior to the others but "comparable"; the gain lies less in the operation's outcome and more in the recovery process. This is why, at a center without robotic access, open or laparoscopic pyeloplasty are valid options, applied with the same content and the same success.

The flow is the same as laparoscopic pyeloplasty; for the family, the difference is small.

• See a doctor: fever (38°C/100.4°F or above), increasing flank or abdominal pain, vomiting, drainage at the port sites, decreased urine output; severe pain or noticeable bleeding while the stent is in place.

• Under general anesthesia, the ports are opened, the robotic arms are docked, and the surgeon moves to the console. Once the repair is complete, a JJ (double-J) stent is left in most cases; it is removed roughly 4–6 weeks later (2–8 weeks depending on the center) under a brief anesthetic via cystoscopy. The stay is generally short; pain is minimal and the port scars are small. The first check-up ultrasound is done at around 3 months.