Robot-assisted pyeloplasty

Abstract

Although many surgical and endoscopic techniques have been described for treating ureteropelvic junction obstruction (UPJO), Anderson Hynes dismembered pyeloplasty remains the preferred option in most cases. This kind of technique is well suitable also for laparoscopic minimally invasive approach. Since its introduction in 1993 by Schuessler et al. (J Urol 150:1795, 1993), laparosopic dismembered pyeloplasy has rapidly become a valid alternative to the more invasive traditional open approach. The long-term results are comparable with those of open surgery with success rates ranging from 90 to >95% (Brooks et al., Urology 46:791-795, 1995; Bauer et al., J Urol 162:692-695, 1999; Klingler et al., Eur Urol 44:340-345, 2003; Cestari et al., Eur Urol 58:711-718, 2010). However, laparoscopic pyeloplasty, both transperitoneal and retroperitoneal approach, remains a challenging procedure and it requires high proficiency in laparoscopic skills especially considering the reconstructive part such as suturing. Even in large series from experienced centers, the operative duration has remained long, usually due to prolonged anastomotic times. Robotic technology overcomes limits of conventional laparoscopy with the three dimensional vision, increased dexterity and greater precision. Therefore, taking into account that reconstructive surgery needs precise intracorporeal suturing, dismembered pyeloplasty is one of the procedures which most likely benefits from robotic assistance.