Robot-assisted laparoscopic ureteral reimplantation in children: a valuable alternative to open surgery.

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Robot-assisted laparoscopic surgical systems have led to new minimally invasive options for complex reconstructive procedures in children including for vesicoureteral reflux (VUR). Robot-assisted laparoscopic ureteral reimplantation has been shown to be a viable minimally invasive surgical option for children with VUR. However, higher-than-expected complication rates and sub-optimal reflux resolution rates at some centers have also been reported. This article provides a focused literature review as well as current perspectives on open reimplantation and robot-assisted laparoscopic ureteral reimplantation as non-endoscopic surgical options for pediatric VUR. The heterogeneity of surgical outcomes may, in part, be due to the learning curve inherent with all new technology and procedures. As a result, the current gold standard surgical option for VUR continues to be open ureteral reimplantation. While it remains to be seen if robot-assisted laparoscopic surgery will gradually replace open surgery as the most utilized surgical option for VUR in pediatric patients, robot-assisted laparoscopic ureteral reimplantation with the current robotic surgical systems may be just one step toward an eventual minimally invasive option that all experienced surgeons can offer with the requisite high success rates and low major complication rates. Robot-assisted laparoscopic ureteral reimplantation remains a viable minimally invasive surgical option for children with VUR, but with the expected learning curve associated with all new technologies.