Surgery in Motion Robot-assisted, Single-site, Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction with the New da Vinci Platform: A Stage 2a Study Nicolo ` Maria Buffi a, *, Giovanni Lughezzani a , Nicola Fossati a , Massimo Lazzeri a , Giorgio Guazzoni a , Giuliana Lista a , Alessandro Larcher a , Alberto Abrate a , Cristian Fiori b , Andrea Cestari c , Francesco Porpiglia b a Department of Urology, San Raffaele Turro Hospital, Milan, Italy; b Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; c Department of Urology, Istituto Auxologico Italiano, Milan, Italy EUROPEAN UROLOGY 67 (2015) 151–156 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted March 3, 2014 Keywords: Robotic surgery Single site Pyeloplasty Ureteropelvic junction obstruction Please visit www.europeanurology.com and www.urosource.com to view the accompanying video. Abstract Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a stage 2a study of robot-assisted single-site (R-LESS) pyeloplasty for ureteropelvic junction obstruction (UPJO). Design, setting, and participants: This study is an investigative pilot study of 30 consecutive cases of R-LESS pyeloplasty performed at two participating institutions between July 2011 and September 2013. Surgical procedure: Dismembered R-LESS pyeloplasty was performed at two surgical centers. Measurements: Feasibility (conversion rate), safety (complication rate and Clavien-Dindo classification), efficacy (clinical outcome) of the procedure were assessed. Results and limitations: The median patient age was 37 yr (range: 19–65 yr) and median body mass index was 23 kg/m 2 (range: 19–29 kg/m 2 ). The median operative time was 160 min (range: 101–300 min), the median postoperative stay was 5 d (range: 3–13 d), and the median time to catheter removal was 3 d (range: 2–10). Two cases required conversion, the first one to standard laparoscopic technique and the second one to standard robotic technique. No intraoperative complications were reported. In three cases, an additional 5-mm trocar was needed. The postoperative complications rate was 26% (n = 8). Most of them were grade 1 complications (n = 4; 13%), followed by grade 2 (n = 3; 10%) and grade 3(n = 1; 3.3%) complications, according to the Clavien-Dindo classification. One patient needed a surgical reintervention with standard robotic technique 3 d after surgery for urinary leakage. The overall success rate, considered as the resolution of symptoms and the absence of functional impairment at postoperative imaging, was 93.3% (n = 28) at a median follow-up of 13 mo (range: 3–21 mo). The main limitations of this study are the limited number of patients included and the short-term follow-up. Conclusions: Single-site robotic pyeloplasty is a feasible technique in selected patients, with good cosmetic results and excellent short-term clinical outcomes. Prospective studies are needed to further assess its role for the treatment of UPJO. Patient summary: Single-site robot-assisted pyeloplasty is a feasible technique with good cosmetic results and excellent short-term clinical outcomes. # 2014 Published by Elsevier B.V. on behalf of European Association of Urology. * Corresponding author. Department of Urology, San Raffaele Turro Hospital, Vita-Salute San Raffaele University, Via Stamira D’Ancona, 20, 20127 Milan, Italy. Tel. +39 02 2643 7286; Fax: +39 02 2643 7298. E-mail address: buffi.nicolomaria@gmail.com (N.M. Buffi). http://dx.doi.org/10.1016/j.eururo.2014.03.001 0302-2838/# 2014 Published by Elsevier B.V. on behalf of European Association of Urology.