Robotic-assisted laparoscopic pyeloplasty(RALP) for Pelvi-Ureteric Junction Obstruction(PUJO) is being increasingly utilised even in children. Complex PUJO, i.e PUJO associated with ectopic kidneys, malrotated kidneys, giant hydronephrosis(HDN), duplex collecting systems, crossing vessels, recurrent PUJO, etc., increase the procedure's complexity many fold. We aim to assess the outcomes of RALP in children with complex PUJO.

All consecutive RALP patients from December 2018 to May 2024 in children under 15 years of age with a complex PUJO were included. Patients were analysed regarding sex, age, complex factors, operative parameters, and postoperative outcomes. All patients had a minimum follow-up of six months

Thirty-One complex PUJO underwent RALP from December 2018 to May 2024 (Right-17, left-14); 6 girls and 25 boys (median 78 months, IQR 12-108), the youngest a 5-month-old with giant hydronephrosis. Fifteen children had Giant HDN(48%), 7 had a redo (22.5%), 3 had a crossing vessel(9.6%), two patients each had ectopic kidney and malrotated kidney(6.4%), one patient each had duplex kidney and cross-fused ectopia(3%). The mean docking and mean operative time were 3.6 and 144.4 minutes. 14 patients(45%) had no drain inserted. Mean hospital stay was 3.2 days(range 2-13). Three patients had post-op urinary tract infection (9.6%) and two readmitted for IV antibiotics(6.4%). 90.3% patients had stable or improved split renal function, 93.5% patients had reduction in TPD post surgery. Overall success rate of RAL pyeloplasty was 96.8%. One had recurrent PUJO (3%).

Our study shows that with an experienced team, even complex PUJO in children can safely undergo RALP with good outcomes.