Even though there is an exponential increase in the utilization of robotic assistance in surgery for children, many doubts still exist regarding its utility in smaller children, possibly due to 8mm ports, large instruments, and perceived need for larger working space. Hence we reviewed children who underwent Robotic Assisted Laparoscopic Pyeloplasty(RALP) to evaluate its safety and outcomes in small children.

Children under 15 kilograms who underwent RALP were reviewed with respect to, docking times, operative duration, complications, conversions, duration of catheter and dj stent and hospital stay. Success of the procedure was evaluated with USG and diuretic renogram over a minimum follow up of six months.

Of the 132 children who underwent RALP over the past 3.5 years, Forty Eight were in children under 15kgs. The Median age/weight was 12 months(IQR 5.5-30m)/ 8.4kg. 87.5% were antenatally diagnosed. The duration of RALP was a median of 126 minutes(IQR 99-153). The average blood loss was 7ml. None needed conversion. The duration of catheter were 1.7 days and drain duration of 2 days(where used), median hospital stay of 2.8 days and dj stent of 6 weeks. My current practice is not to use any drains. Early complications included three patients with a prolonged urinary leak, treated conservatively. Five patients had UTI requiring antibiotics. On a follow-up of more than six months, Median Transverse Pelvic Diameter(TPD) reduced from 3.42 cms to 1.8cms. On diuretic renograpy, drainage improved in 47 of 48 patients with no drop in function. Only one had recurrence requiring redo.

RALP, with minimal modifications and attention to detail, can also be performed in small children safely with good outcomes. We describe modifications to make this procedure safe with good outcomes.