• Igor Sorokin
  • Jeffrey A. Cadeddu


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.


Robotic pyeloplasty Complications Ureteropelvic junction obstruction RALP Laparoendoscopic single-site surgery 


  1. 1.
    Seideman CA, Bagrodia A, Gahan J, et al. Robotic-assisted pyeloplasty: recent developments in efficacy, outcomes, and new techniques. Curr Urol Rep. 2013;14:37.CrossRefPubMedGoogle Scholar
  2. 2.
    Sung GT, Gill IS, Hsu TH. Robotic-assisted laparoscopic pyeloplasty: a pilot study. Urology. 1999;53:1099.CrossRefPubMedGoogle Scholar
  3. 3.
    Gettman MT, Neururer R, Bartsch G, et al. Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology. 2002;60:509.CrossRefPubMedGoogle Scholar
  4. 4.
    Van Batavia JP, Casale P. Robotic surgery in pediatric urology. Curr Urol Rep. 2014;15:402.CrossRefPubMedGoogle Scholar
  5. 5.
    Khanna R, Stein RJ, White MA, et al. Single institution experience with robot-assisted laparoendoscopic single-site renal procedures. J Endourol. 2012;26:230.CrossRefPubMedGoogle Scholar
  6. 6.
    Merseburger AS, Herrmann TR, Shariat SF, et al. EAU guidelines on robotic and single-site surgery in urology. Eur Urol. 2013;64:277.CrossRefPubMedGoogle Scholar
  7. 7.
    Braga LH, Pace K, DeMaria J, et al. Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate. Eur Urol. 2009;56:848.CrossRefPubMedGoogle Scholar
  8. 8.
    Uberoi J, Disick GI, Munver R. Minimally invasive surgical management of pelvic-ureteric junction obstruction: update on the current status of robotic-assisted pyeloplasty. BJU Int. 2009;104:1722.CrossRefPubMedGoogle Scholar
  9. 9.
    Best SL, Donnally C, Mir SA, et al. Complications during the initial experience with laparoendoscopic single-site pyeloplasty. BJU Int. 2011;108:1326.CrossRefPubMedGoogle Scholar
  10. 10.
    Brandao LF, Laydner H, Zargar H, et al. Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: a systematic review and meta-analysis. Urol Ann. 2015;7:289.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Joseph RA, Goh AC, Cuevas SP, et al. “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc. 2010;24:1331.CrossRefPubMedGoogle Scholar
  12. 12.
    Buffi NM, Lughezzani G, Fossati N, et al. Robot-assisted, single-site, dismembered pyeloplasty for ureteropelvic junction obstruction with the new da Vinci platform: a stage 2a study. Eur Urol. 2015;67:151.CrossRefPubMedGoogle Scholar
  13. 13.
    Law J, Rowe N, Archambault J, et al. First Canadian experience with robotic single-incision pyeloplasty: comparison with multi-incision technique. Can Urol Assoc J. 2016;10:83.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Olweny EO, Park SK, Tan YK, et al. Perioperative comparison of robotic assisted laparoendoscopic single-site (LESS) pyeloplasty versus conventional LESS pyeloplasty. Eur Urol. 2012;61:410.CrossRefPubMedGoogle Scholar
  15. 15.
    Tobis S, Houman J, Thomer M, et al. Robot-assisted transumbilical laparoendoscopic single-site pyeloplasty: technique and perioperative outcomes from a single institution. J Laparoendosc Adv Surg Tech A. 2013;23:702.CrossRefPubMedGoogle Scholar
  16. 16.
    Cestari A, Buffi NM, Lista G, et al. Retroperitoneal and transperitoneal robot-assisted pyeloplasty in adults: techniques and results. Eur Urol. 2010;58:711.CrossRefPubMedGoogle Scholar
  17. 17.
    Viterbo R, Greenberg RE, Al-Saleem T, et al. Prior abdominal surgery and radiation do not complicate the retroperitoneoscopic approach to the kidney or adrenal gland. J Urol. 2005;174:446.CrossRefPubMedGoogle Scholar
  18. 18.
    Hyams ES, Kanofsky JA, Stifelman MD. Laparoscopic Doppler technology: applications in laparoscopic pyeloplasty and radical and partial nephrectomy. Urology. 2008;71:952.CrossRefPubMedGoogle Scholar
  19. 19.
    Atug F, Burgess SV, Castle EP, et al. Role of robotics in the management of secondary ureteropelvic junction obstruction. Int J Clin Pract. 2006;60:9.CrossRefPubMedGoogle Scholar
  20. 20.
    Niver BE, Agalliu I, Bareket R, et al. Analysis of robotic-assisted laparoscopic pyleloplasty for primary versus secondary repair in 119 consecutive cases. Urology. 2012;79:689.CrossRefPubMedGoogle Scholar
  21. 21.
    Thiel DD. Navigating the difficult robotic assisted pyeloplasty. ISRN Urol. 2012;291235:2012.Google Scholar
  22. 22.
    Hemal AK, Mishra S, Mukharjee S, et al. Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair. Int J Urol. 2008;15:744.CrossRefPubMedGoogle Scholar
  23. 23.
    Mufarrij PW, Woods M, Shah OD, et al. Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol. 2008;180:1391.CrossRefPubMedGoogle Scholar
  24. 24.
    Tewari AK, Srivastava A, Sooriakumaran P, et al. Use of a novel absorbable barbed plastic surgical suture enables a “self-cinching” technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol. 2010;24:1645.CrossRefPubMedGoogle Scholar
  25. 25.
    Weld KJ, Ames CD, Hruby G, et al. Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction. Urology. 2006;67:1133.CrossRefPubMedGoogle Scholar
  26. 26.
    Liatsikos E, Knoll T, Kyriazis I, et al. Unfavorable outcomes of laparoscopic pyeloplasty using barbed sutures: a multi-center experience. World J Urol. 2013;31:1441.CrossRefPubMedGoogle Scholar
  27. 27.
    Sorokin I, O'Malley RL, McCandless BK, et al. Successful outcomes in robot-assisted laparoscopic pyeloplasty using a unidirectional barbed suture. J Endourol. 2016;30:660.CrossRefPubMedGoogle Scholar
  28. 28.
    Shah HN, Nayyar R, Rajamahanty S, et al. Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience. Int Urol Nephrol. 2012;44:775.CrossRefPubMedGoogle Scholar
  29. 29.
    Stravodimos K, Katafigiotis I, Fragkiadis E, et al. Correcting and sharing our complications. Misplacement of pigtail catheter, during a Robot Assisted Pyeloplasty. Clinical findings, diagnosis, possible causes and endoscopic treatment. Arch Ital Urol Androl. 2015;87:165.CrossRefPubMedGoogle Scholar
  30. 30.
    Stein RJ, White WM, Goel RK, et al. Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol. 2010;57:132.CrossRefPubMedGoogle Scholar
  31. 31.
    Cadeddu JA, Regan F, Kavoussi LR, et al. The role of computerized tomography in the evaluation of complications after laparoscopic urological surgery. J Urol. 1997;158:1349.CrossRefPubMedGoogle Scholar
  32. 32.
    Etafy M, Pick D, Said S, et al. Robotic pyeloplasty: the University of California-Irvine experience. J Urol. 2011;185:2196.CrossRefPubMedGoogle Scholar
  33. 33.
    Gupta NP, Nayyar R, Hemal AK, et al. Outcome analysis of robotic pyeloplasty: a large single-centre experience. BJU Int. 2010;105:980.CrossRefPubMedGoogle Scholar
  34. 34.
    Hopf HL, Bahler CD, Sundaram CP. Long-term outcomes of robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction. Urology. 2016;90:106.CrossRefPubMedGoogle Scholar
  35. 35.
    Schwentner C, Pelzer A, Neururer R, et al. Robotic Anderson-Hynes pyeloplasty: 5-year experience of one centre. BJU Int. 2007;100:880.CrossRefPubMedGoogle Scholar
  36. 36.
    Sivaraman A, Leveillee RJ, Patel MB, et al. Robot-assisted laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: a multi-institutional experience. Urology. 2012;79:351.CrossRefPubMedGoogle Scholar
  37. 37.
    Danuser H, Germann C, Pelzer N, et al. One- vs 4-week stent placement after laparoscopic and robot-assisted pyeloplasty: results of a prospective randomised single-centre study. BJU Int. 2014;113:931.CrossRefPubMedGoogle Scholar
  38. 38.
    Soulie M, Salomon L, Patard JJ, et al. Extraperitoneal laparoscopic pyeloplasty: a multicenter study of 55 procedures. J Urol. 2001;166:48.CrossRefPubMedGoogle Scholar
  39. 39.
    Ozayar A, Morgan MS, Friedlander JI, et al. Prompt management of anastomotic leak or acute obstruction after minimally invasive pyeloplasty with percutaneous nephrostomy preserves outcomes. J Urol. 2014;192:1716.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.UT Southwestern Medical CenterDallasUSA
  2. 2.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations