Robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidneys: results of a multicentric study

  • Ciro EspositoEmail author
  • Lorenzo Masieri
  • Thomas Blanc
  • Gianantonio Manzoni
  • Selcuk Silay
  • Maria Escolino
Original Article



This multicentric study aimed to report our experience with robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidney (HSK).


The records of 14 patients (11 boys and 3 girls with an average age of 9 years), who underwent RALP for repair of pelvi–ureteric junction obstruction (PUJO) in HSK in five international pediatric urology units over a 5-year period, were retrospectively reviewed. A dismembered pyeloplasty with no division of isthmus was performed in all the cases.


The average operative time including docking was 143.5 min (range 100–205). No conversions to laparoscopy or open surgery or intra-operative complications occurred. Patients were discharged on postoperative day 2 following catheter and drain removal. The JJ stent was removed at mean 33 days postoperatively. Overall success rate was 92.8%. As for postoperative complications, we recorded a urinary tract infection (UTI) and stent-related irritative symptoms, managed with medical therapy, in two patients (II Clavien) and an anastomotic stricture in one patient needing surgical revision with no further recurrence (IIIb Clavien). At follow-up, all the patients (one after redo-surgery) reported complete resolution of symptoms, improvement of hydronephrosis on ultrasound and no residual obstruction on diuretic renogram.


Our experience suggested that RALP in HSK is safe, feasible and with good medium-term outcomes in expert hands. An accurate pre-operative planning associated with a standardized technique is key points to achieve good surgical and functional outcomes in these challenging cases. The da Vinci robot technology offers the advantages of MIS procedures and overcomes the technical challenges of laparoscopic approach.


Horseshoe kidney Robot Pyeloplasty Children Technique Complications 


Author contribution

CE: project development, data collection, manuscript writing, and manuscript editing; LM: data collection, data analysis, and manuscript editing; TB: data collection, data analysis, and manuscript editing; GM: data collection, data analysis, and manuscript editing; SS: data collection, data analysis, and manuscript editing; ME: project development, data analysis, manuscript writing, and manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ciro Esposito
    • 1
    Email author
  • Lorenzo Masieri
    • 2
  • Thomas Blanc
    • 3
  • Gianantonio Manzoni
    • 4
  • Selcuk Silay
    • 5
  • Maria Escolino
    • 1
  1. 1.Division of Pediatric UrologyFederico II University of NaplesNaplesItaly
  2. 2.Division of Pediatric UrologyMeyer Children HospitalFlorenceItaly
  3. 3.Division of Pediatric UrologyHôpital Necker-Enfants MaladesParisFrance
  4. 4.Division of Pediatric UrologyOspedale Maggiore PoliclinicoMilanItaly
  5. 5.Division of Pediatric UrologyIstanbul Medeniyet UniversityIstanbulTurkey

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