Minimally invasive surgical management of pelvic-ureteric junction obstruction: update on the current status of robotic-assisted pyeloplasty.

BACKGROUND: Pelvi-ureteric junction (PUJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Historically, open pyeloplasty and endoscopic techniques have been the main surgical options with the intent of complete excision or incision of the obstruction. The advent of laparoscopy and robotic-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. AIMS We review the current status of robotic-assisted laparoscopic pyeloplasty and report on the result, continuing evolution, and potential role for this surgical procedure.

MATERIALS AND METHODS: A review of the recent literature encompassing laparoscopic and robotic-assisted pyeloplasty was conducted with particular attention to operative techniques, surgical outcomes, and complication rates.

RESULTS: Laparoscopic and robotic-assisted approaches are able to duplicate the open technique, and not surprisingly, are now being shown to be as efficacious as the gold standard open approach. The laparoscopic remains technically challenging due to the high proficiency level required for intracorporeal suturing, although added experience has resulted in shorter operative times. The advent of robotics has further expanded the breadth of this reconstructive procedure while preserving the benefits of decreased pain, shorter hospitalization, rapid convalescence, and an improved cosmetic result.

DISCUSSION: The introduction of robotics to the field of minimally invasive surgery facilitates this procedure and may allow for more widespread implementation by surgeons of varying skill levels. These benefits must be balanced against the increased costs of the robotic platform.

CONCLUSION: Clinical reports have demonstrated that robotic-assisted pyeloplasty is a safe, feasible, and effective technique for treating ureteropelvic junction obstruction in short term studies. Additional studies with prolonged follow-up will ultimately provide valuable information as to the long-term efficacy of robotic-assisted laparoscopic pyeloplasty.