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Background <p>Robot-assisted laparoscopic surgery (RALS) is increasingly utilized in pediatric urology. However, defining its precise clinical advantage over conventional laparoscopy (CL) or open surgery remains essential due to significant financial overhead.</p> Objective <p>This narrative review synthesizes current evidence to establish a clinical framework delineating when CL is sufficient versus when RALS offers definitive therapeutic benefits.</p> Methods <p>A structured literature search was conducted across PubMed, Embase, and Google Scholar for English-language publications from 2020 to 2025. Preference was given to systematic reviews, comparative cohort studies, and multicenter series. Qualitative synthesis was performed on 24 included studies.</p> Results <p>For upper and lower urinary tract reconstructions, RALS achieves high functional success rates (94–100%). Meta-analyses of pyeloplasty demonstrate equivalent success (~ 95%) and complication profiles between robot-assisted pyeloplasty (RALP) and CL, though RALP significantly reduces hospital length of stay and operative times. For vesicoureteral reflux, robot-assisted laparoscopic ureteral reimplantation yields a 94.1% success rate at a 15.1-month median follow-up, with no significant difference in complications. In partial nephrectomies, RALS lowers postoperative narcotic requirements, reduces blood loss, and shortens hospital stay, while guiding complex anatomy dissection. Conversely, CL remains preferred for simple extirpative procedures and in infants weighing &lt; 10&#xa0;kg due to smaller 2–3&#xa0;mm port sizes that minimize mechanical arm collisions.</p> Conclusion <p>RALS serves as a safe, highly effective alternative and an emerging minimally invasive option for intricate pediatric urological reconstructions. Surgical decision-making should follow a procedure-specific, individualized approach that balances technological advantages against institutional expertise, case volume, and resources.</p>

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Robot-assisted versus conventional laparoscopic surgery in pediatric urology: a narrative review for a balanced approach

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Ramesh Babu

摘要

Background

Robot-assisted laparoscopic surgery (RALS) is increasingly utilized in pediatric urology. However, defining its precise clinical advantage over conventional laparoscopy (CL) or open surgery remains essential due to significant financial overhead.

Objective

This narrative review synthesizes current evidence to establish a clinical framework delineating when CL is sufficient versus when RALS offers definitive therapeutic benefits.

Methods

A structured literature search was conducted across PubMed, Embase, and Google Scholar for English-language publications from 2020 to 2025. Preference was given to systematic reviews, comparative cohort studies, and multicenter series. Qualitative synthesis was performed on 24 included studies.

Results

For upper and lower urinary tract reconstructions, RALS achieves high functional success rates (94–100%). Meta-analyses of pyeloplasty demonstrate equivalent success (~ 95%) and complication profiles between robot-assisted pyeloplasty (RALP) and CL, though RALP significantly reduces hospital length of stay and operative times. For vesicoureteral reflux, robot-assisted laparoscopic ureteral reimplantation yields a 94.1% success rate at a 15.1-month median follow-up, with no significant difference in complications. In partial nephrectomies, RALS lowers postoperative narcotic requirements, reduces blood loss, and shortens hospital stay, while guiding complex anatomy dissection. Conversely, CL remains preferred for simple extirpative procedures and in infants weighing < 10 kg due to smaller 2–3 mm port sizes that minimize mechanical arm collisions.

Conclusion

RALS serves as a safe, highly effective alternative and an emerging minimally invasive option for intricate pediatric urological reconstructions. Surgical decision-making should follow a procedure-specific, individualized approach that balances technological advantages against institutional expertise, case volume, and resources.