Robotic assisted laparoscopic pyeloplasty

Dismembered pyeloplasty is the gold standard treatment for adult ureteropelvic junction obstruction with published success rates consistently over 90%. The morbidity of the open flank incision required for dismembered pyeloplasty led to experimentation with other less invasive modalities such as endopyelotomy and laparoscopic techniques. Modern laparoscopic pyeloplasty series demonstrate success rates equivalent to those of their open counterparts with improved postoperative convalescence. The requirement of complex intracorporeal reconstruction has limited widespread application of laparoscopic pyeloplasty. The daVinci surgical robotic platform offers features that improve intracorporeal reconstruction and suturing thereby flattening the learning curve of laparoscopic pyeloplasty for residents, fellows, and novice laparoscopists. Multiple variations in robotic technique exist but short term outcomes and convalescence appear equivalent to open and laparoscopic pyeloplasty. Complications related to robotic assisted laparoscopic pyeloplasty are minimal and usually self-limiting. The indications for robotic pyeloplasty have expanded to include difficult cases such as those who have failed previous therapy for ureteropelvic junction obstruction including failed endopyelotomy or previous pyeloplasty. The appeal of robotic technology is tempered somewhat by its high cost compared to standard laparoscopic techniques but it is hoped that overall costs will decrease with time.