OBJECTIVE Laparoscopic urinary tract surgery is rarely performed in small infants. We compared the safety, feasibility and outcome of laparoscopic urinary tract surgery in children weighing 6 kg or less with a weight matched cohort undergoing open urinary tract surgery. METHODS We performed a retrospective nonrandomized chart review comparing 17 infants weighing 6 kg or less who underwent laparoscopic urinary tract surgery beginning in 2005 with a weight matched historical group of 18 patients who had undergone open urinary tract surgery. We recorded procedures performed, operative times, blood loss, length of hospitalization, preoperative and postoperative hemoglobin and serum creatinine levels, analgesia requirements, complications and outcomes. Urine output during anesthesia was recorded and expressed as ml/kg per hour. We also recorded intraoperative changes in heart rate, mean arterial blood pressure, peak inspiratory pressure, respiratory rate, oxygen saturation, CO(2) and core body temperature. RESULTS Estimated blood loss was minimal in all cases. Mean operative time +/- SD was 201 +/- 72 minutes in the laparoscopic group and 112 +/- 36 minutes in the open group (p <0.01). Patients undergoing laparoscopic surgery had lower intraoperative urine output but no changes in preoperative or postoperative serum creatinine levels. Mean postoperative hospitalization +/- SD was 2 +/- 1 days in the laparoscopic group and 3.2 +/- 2.18 days in the open group. Mean opioid requirement (morphine equivalent) +/- SD was higher in the open group, at 0.24 +/- 0.15 mg/kg, compared to the laparoscopic group, at 0.13 +/- 0.19 mg/kg. Operation related complications were diagnosed in 1 patient (6%) from the laparoscopic group and 2 patients (11%) from the open group. CONCLUSIONS Laparoscopic urinary tract surgery can be performed safely in neonates and small infants with outcomes comparable to that of open surgery, with decreased analgesia requirements and faster recovery.