Pyeloplasty

Robotic-assisted laparoscopic pyeloplasty is a popular procedure to manage ureteropelvic junction obstruction in the current era. Robotic-assistance is particularly helpful to aid reconstructive procedures such as pyeloplasty with the benefits of three-dimensional vision and tremor control for intracorporeal suturing. Robotic laparoendoscopic single-site pyeloplasty is a popular technique as ureteropelvic junction obstruction occurs in a younger patient population likely more interested in aesthetic outcomes. Other potential advantages of laparoendoscopic single-site procedures include the potential for lower rate of port-site complications, less pain, and faster recovery times. Robotic pyeloplasty is usually compared to conventional laparoscopic pyeloplasty and both show similar rates of success and complications. Learning curve is a big risk factor for complications and conversions in both robotic single-port and multiport approaches. Prevention of complications is accomplished by strategic preoperative planning and delicate tissue handling. All videos of robotic pyeloplasty procedures should be recorded and easily retrieved for review. Urine leak is the major complication that occurs and should be managed urgently, preferably with percutaneous nephrostomy drainage. Failure rates after robotic pyeloplasty are quite low and the need for secondary procedures is rare.