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Robotic Pyeloplasty Is a Viable Option for Infants Younger Than 6 Months

Robotic Pyeloplasty Is a Viable Option for Infants Younger Than 6 Months 1024 677 Lauren Dembeck
Dr. DaJusta, urologist, standing in a hospital hallway smiling.

A Nationwide Children’s study found comparable outcomes with robotic and open pyeloplasty in infants younger than 6 months, suggesting patient size alone should not preclude a robotic approach.

 

Robotic pyeloplasty appears to be a viable alternative to open surgery even in infants younger than 6 months, with comparable surgical success and postoperative outcomes, according to a study published in the Journal of Pediatric Urology.

Pyeloplasty is performed to correct ureteropelvic junction obstruction (UPJO), a blockage where the kidney drains into the ureter that can lead to hydronephrosis. Although robotic pyeloplasty has become increasingly common in pediatric urology, it has traditionally been used more often in older and larger children because of concerns about the limited intra-abdominal working space available in young infants.

“One of the questions was whether these very small infants are simply too small for robotic surgery,” says Daniel G. DaJusta, MD, pediatric urologist at Nationwide Children’s Hospital and senior author of the study. “We weren’t necessarily trying to show that the robot was better. We wanted to determine whether it could be a safe, feasible alternative with outcomes comparable to open surgery.”

Researchers at Nationwide Children’s retrospectively compared 32 infants younger than 6 months who underwent robotic or open pyeloplasty between 2020 and 2024. Each group included 16 infants. The median age at surgery was 4 months. Surgical success was defined as a greater than 50% reduction in renal pelvis anteroposterior diameter one year after surgery.

The team found no significant differences between groups in surgical success, postoperative complications, length of hospital stay, or narcotic use. Robotic procedures took significantly longer, with a median operative time of 209.5 minutes compared with 142.5 minutes for open surgery.

From a surgeon’s perspective, however, robotics may offer technical advantages even in very small patients.

“The robot provides substantial magnification and allows the kidney and renal pelvis to remain in their natural position while we operate,” Dr. DaJusta explains. “It also reduces tremor and can make the suturing very precise.”

He adds that demonstrating comparable outcomes may become increasingly relevant as more pediatric urologists perform most pyeloplasties robotically and have less routine experience with the open approach.

“For a surgeon who is more comfortable performing the operation robotically, it is reassuring to know that a very young infant does not necessarily have to be excluded simply because of size,” he says. “These patients can still do very well.”

 

Reference

Bain A, Morin J, Sion A, Smith J, Zhang Y, Alpert S, Jayanthi VR, Baker L, Ching CB, McLeod D, Fuchs ME, DaJusta DG. Comparison of clinical outcomes of robotic versus open pyeloplasty in infants under 6 months. J Pediatr Urol. 2026 Oct;22(5):106133. doi: 10.1016/j.jpurol.2026.106133.

 

About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.

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