Background: To assess the utility of robotic assisted laparoscopic dismembered pyeloplasty (RALP) in children we compared an age-matched cohort undergoing open dismembered pyeloplasty (OPN) to RALP for safety, efficacy, operative time, blood loss, in-hospital narcotic use, and length of stay (LOS).
Methods: We performed a retrospective case-control study from 2000 - 2004 of 33 RALP patients and 33 OPN. Average age in each group was not significantly different (7.8-RALP vs. 7.6-OPN years, p = 0.75). Mean follow-up of the RALP and OPN group was 10 and 21 months, respectively.
Results: Etiology of the obstruction was not significantly different. Mean operative time was significantly less in OPN (181-OPN, 219-RALP minutes, p=0.031). As RALP experience increased operative times improved and approached the OPN experience. RALP complications included one requiring reoperative surgery versus none in OPN (p=0.15). RALP patients had a mean LOS of 2.3 days as opposed to 3.5 days for OPN (p=<0.001). Total narcotic requirements were significantly less in RALP (p=0.001). All patients in OPN and 31 patients in RALP had either resolution of hydronephrosis, improvement in drainage, or relief of symptoms.
Conclusions: We have documented the safety and efficacy in children. RALP showed advantages of decreased hospital stay, decreased narcotic use and operative times that approach open. RALP is an option for pyeloplasty and as robotic technology improves, this method of repair may become the minimally invasive treatment of choice.

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