Ureteropelvic Junction Obstruction: Robot-Assisted Pyeloplasty

Abstract

The standard treatment of ureteropelvic junction obstruction (UPJO) is represented by the Anderson-Hynes dismembered pyeloplasty, even if different approaches, both surgical and endoscopic, have been described. Robot-assisted pyeloplasty (RP) is a feasible and safe approach. The indications for the robotic approach remain the same as those for the laparoscopic or open pyeloplasty. Every patient with symptomatic UPJO, or with decreasing renal function in the presence of UPJO, should undergo RP. The transperitoneal, retroperitoneal, and transmesocolic approaches are described focusing on advantages and disadvan-tages of each approach. Robot-assisted pyeloplasty has excellent success rates for relief of obstruction and very low peri- and post-operative morbidity. The robotic surgical technique maintains the advantages of laparoscopic surgery providing a more precise manipulation and visualization, and a faster learning curve. Comparative studies are reported to confront the different techniques. Secondary minimally invasive pyeloplasty is obviously a more challenging procedure due to the fibrosis and the adhesions formed after the previous surgery. Newer techniques and indications such as the employment of buccal mucosal graft, the single port approach, and indocyanine green injection are described. Tips and tricks to keep in mind during this kind of procedure are listed in order to report our experience in this setting.