© 2008 THE AUTHORS 136 JOURNAL COMPILATION © 2 0 0 8 B J U I N T E R N A T I O N A L | 1 0 2 , 1 3 6 – 1 5 1 | doi:10.1111/j.1464-410X.2008.07711.x MURPHY ET AL. Surgery Illustrated – Surgical Atlas Robotically assisted laparoscopic pyeloplasty Declan Murphy, Ben Challacombe, Oussama Elhage, Mohammad Shamim Khan and Prokar Dasgupta Department of Urology, Guy’s & St Thomas’ NHS Foundation, London, UK Accepted for publication 2008 ILLUSTRATIONS by STEPHAN SPITZER, www.spitzer-illustration.com KEYWORDS robotic, da Vinci, laparoscopy, pyeloplasty, technique INTRODUCTION Although several endourological, open and laparoscopic procedures have been used to manage PUJ obstruction, there remains little doubt that dismembered (Anderson-Hynes) pyeloplasty remains the preferred option in most cases (Fig. 1). It is also clear that this procedure is very well suited to the laparoscopic approach, whether by the transperitoneal or retroperitoneal route. However, dismembered pyeloplasty via the laparoscopic approach remains a challenging procedure to those without considerable laparoscopic experience. Intracorporeal suturing skills are required to complete the reconstruction of the PUJ after resection of the adynamic ureteric segment and reduction of the distended renal pelvis. Even in large series from experienced centres, the operative duration has remained long, usually due to prolonged anastomotic times. Although there is no level I or II evidence to justify the superiority of the laparoscopic over the open approach, it appears likely that the benefits to patients of the minimally invasive approach are substantial, and that this approach is preferred where available. The arrival of robotic technology to assist in complex laparoscopic procedures has been noteworthy. Although the da Vinci® surgical system (Intuitive Surgical Inc., CA, USA) has received most acclaim for its penetration into the radical prostatectomy market, many of its technological attributes are well suited to laparoscopic dismembered pyeloplasty. In 2008 THE AUTHORS Surgery Illustrated SURGERY ILLUSTRATEDMURPHY ET AL BJUI BJU INTERNATIONAL