Background: The success of laparoscopic partial nephrectomy in the pediatric population invites the exploration of a robotic assisted approach. There is limited data in the literature on robotic laparoscopic partial nephrectomy in adults, let alone children. We aimed to assess the safety and viability of robotic assisted laparoscopic partial nephrectomy (RALPN) in children.
Methods: We reviewed 10 patients who underwent RALPN by three different surgeons using the da Vinci^® robotic system with a single surgeon serving as the proctor for all cases. We provide a summary of operative time, length of stay, complications and follow up results in these patients.

Results: All cases were completed successfully with the robotic laparoscopic approach. Mean patient age was 9.9 years (range 0.5 -33 years, including 1 adult with duplication anomaly). 5 underwent upper pole RALPN while the remaining 5 had lower pole RALPN. 5 patients had ectopic ureters (4 upper poles, 1 lower pole.) 1 patient had right lower pole vesicoureteral reflux (VUR) and left VUR. 3 patients had VUR into a lower pole moiety. Finally 1 patient had a cystic malformation of the right upper pole. Mean operative time was 216 minutes (range 149-310 minutes). Mean length of hospitalization was 2.2 days (range 1-4 days). The single complication in this group was urinoma that was drained percutaneously. 8 patients have had post-operative renal ultrasounds showing a normal remaining renal moiety on the operative side. 2 patients have not yet had follow up ultrasounds. Mean follow up time was 4.5 months.
Conclusions: Robot assisted laparoscopy is a feasible and safe approach to pediatric partial nephrectomy regardless of the pathology or the renal moiety involved. It has been suggested that lower pole partial nephrectomy poses an increased challenge when approached laparoscopically. This does not appear to be the case in our series of RALPN. In fact, there were an equal number of upper and lower pole nephrectomies completed successfully. Reasonable operative times and lengths of hospitalization make this procedure a viable and potentially preferable option for partial nephrectomy especially in children. Moreover, it is clear that surgeons with varying levels of laparoscopic expertise can perform the procedure safely. Further investigation to compare the efficacy of RALPN to open and free-hand laparoscopy should be performed with a larger cohort of patients.

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