The small caliber of a child's ureter makes pyeloplasty a difficult procedure. For this reason, dismembered pyeloplasty is not ideal in children younger than six months and should be avoided. However, this technique remains the preferred method for treating ureteropelvic junction obstruction in older children and the open dismembered pyelo-plasty is the gold standard.
Children's body habitus requires smaller instrumentation and fine 6.0 sutures for the ureteropelvic junction reconstruction. The first laparoscopic dismembered pyelo-plasty in a pediatric patient was performed by Peters et al. (34) when 3 mm laparoscopic ports and instruments became available.
Available series of laparoscopic dismembered pyeloplasty showed excellent results, thus confirming the feasibility and safety of this procedure in this patient population (Table 4) (13,14,35).
Both transperitoneal and retroperitoneal routes, and lower insufflation pressures (12 mmHg) were employed. Recently robot-assisted pyeloplasty was performed using the da Vinci Surgical Systema with equally good results in a series of 13 children older than 3.5 years (36). However, longer follow-up and further evaluation of the metabolic effects of CO2 insufflation in children undergoing laparoscopic surgery are awaited before establishing laparoscopic pyeloplasty the standard of care in this population.
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