Minimally Invasive Surgery in Pediatric Urology

Because minimally invasive surgery uses smaller incisions, your child will experience less pain and scarring, and experience faster recovery as compared to standard "open" surgery, where a large incision is made. This means reduced use of opioids for pain management and shorter hospital stays.

While minimally invasive surgery has many benefits, in some cases “open surgery” techniques are still the preferred treatment method. We will partner with your family to discuss options and select the best surgical approach for your child depending on their unique health situation and condition.

The following minimally invasive surgical approaches are available to children being treated at Children’s Hospital of Philadelphia:

If a procedure involves complex reconstruction, a surgical robot may be used. Robotic surgery facilitates even the most difficult urologic surgical reconstruction by reproducing the hand and wrist motions of a surgeon and also providing a 3D view of the surgical field. The robot uses very fine movements resulting in minimal trauma to tissue.

Robot-assisted Ureteroureterostomy

Treatment for duplex kidney and ureterocele spanned from before birth to a robotic surgery.

Since it launched in the early 2000’s, CHOP’s robotic surgery program has led the way in creating innovative approaches to surgical reconstruction for children with complex urologic conditions. Our team has performed more than 1,500 robotic urology procedures since the program began, making it one of the most experienced pediatric urology robotic surgery programs in the world.

We perform robotic surgery for urology conditions on infants as young as two months of age, all the way through adolescence and young adulthood. Our team is devoted to providing excellent outcomes while ensuring rapid recovery and minimizing pain.

Robotic surgeries used to treat disease of the urinary system include:

• Pyeloplasty
• Redo pyeloplasty, including ureterocalicostomy
• Ureteral reimplant (dismembered and extravesical)
• Creation of appendicovesicostomy (for neurogenic bladder)
• Bladder diverticulectomy
• Ureterocalycostomy
• Bladder augmentation for neurogenic bladder

Laparoscopic urology surgery is a type of minimally invasive surgery that enables surgeons to operate on very precise areas of the body. In laparoscopic surgery, several tiny incisions are made through which narrow tubes are inserted. Surgical instruments and cameras are passed through these tubes, allowing the surgeon to see and perform delicate procedures.

Our team performs single-site, retroperitoneal and transperitoneal laparoscopic surgeries. Laparoscopic surgeries are performed for undescended testicles, hernias and/or hydroceles, removal of a kidney, removing part of non-functioning kidney, etc. A surgical robot assists with certain laparoscopic surgeries.

Laparoscopic urology procedures offered at CHOP include:

• Orchiopexy (surgery for undescended testis)
• Hernia repair
• Partial nephrectomy (removing a diseased portion of a kidney while leaving normal kidney tissue uninjured)
• Total nephrectomy (complete removal of a diseased kidney)
• Nephroureterectomy
• Pyeloplasty
• Ureteral reimplant
• Removal of renal cyst
• Single-site laparoscopy

In endoscopic urology procedures, we use tiny cameras with a working channel (scopes) that enter the urinary system through natural openings in the body like the urethra, which eliminates the need for skin incisions. The surgeon looks at a video screen, which displays the magnified images of the body's internal structures. The surgeon moves the endoscope in the organ system and operates with thin, precise instruments.

Our team performs endoscopic surgery primarily to manage kidney stones, calyceal diverticulum, ureteroceles, and low-grade vesicoureteral reflux.

Keeping your child safe while achieving the best possible outcomes is our top priority when performing endoscopic urology procedures in children. We use the most advanced technology and surgical instruments specially designed for use in children, including digital ureteroscopes, ultrasound guidance and laser technology. These tools help us avoid unnecessary exposure to radiation and reduce the time a child is under anesthesia, further improving the safety and success of the procedure. 

Endoscopic urology surgeries include:

• Urethroscopy
• Cystoscopy, including valve resection
• Deflux injection into bladder
• Ureteroscopy – In a ureteroscopy, a long, thin fiberoptic telescope (ureteroscope) is inserted through the urethra and passed through the bladder to the kidney stone. It is used to remove or break up (fragment) stones with a laser. A small tube (or stent) may be left in the ureter for a few days after treatment to promote healing and prevent blockage from swelling or spasm. This is performed in an outpatient setting.
• Percutaneous nephrolithotomy (PCNL) – Percutaneous (through needle-puncture of the skin) removal of kidney stones (lithotomy) is accomplished by threading various catheters directly into the kidney and manipulating surgical instruments through the catheters to fragment and remove even the largest kidney stones. This procedure usually requires hospitalization and most patients resume normal activity within two weeks.
• Lithotripsy – This procedure is effective for stones in the kidney or upper ureter. It uses an instrument, machine or probe to break the stone into tiny particles that can pass naturally. Lithotripsy is not appropriate for patients with very large stones or other medical conditions. This is performed in an outpatient setting.

A global pioneer in adapting minimally invasive surgery to the care of children with urologic diseases, the Division of Urology at the Children’s Hospital of Philadelphia (CHOP) offers the most innovative and comprehensive care for various urologic conditions and diagnoses requiring surgery.

Children’s Hospital of Philadelphia is one of the busiest minimally invasive pediatric urologic surgical centers in the country, with hundreds of patients treated each year.

Your child will have access to state-of-the-art instrumentation and a dedicated operating room, as well as the expertise of CHOP’s specially trained pediatric anesthesiology and pain management specialists who are specially trained to understand the correct dose of medication required to control your child’s pain. Using less medication allows your child to spend less time recovering from anesthesia and reduces the chance of side effects.

Our team of experts includes world leaders in urologic surgery who are constantly seeking to improve care, find new treatment options and improve outcomes. We are actively involved in clinical research, safety and quality improvement programs.