ROBOTIC-ASSISTED LAPAROSCOPIC DISMEMBERED PYELOPLASTY VIPUL PATEL ABSTRACT Objectives. To evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparo- scopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing. Methods. A total of 50 patients underwent robotic-assisted laparoscopic dismembered pyeloplasty. A four-trocar technique was used. Most patients were discharged home on day 1, with stent removal at 3 weeks. Patency of the ureteropelvic junction was assessed in all patients with mercaptotriglycylglycine Lasix renograms at 1, 3, 6, 9, and 12 months, then every 6 months for 1 year, and then yearly. Results. Each patient underwent a successful procedure without open conversion or transfusion. The average estimated blood loss was 40 mL. The operative time averaged 122 minutes (range 60 to 330) overall. Crossing vessels were present in 30% of the patients and were preserved in all cases. The time for the anastomosis averaged 20 minutes (range 10 to 100). Intraoperatively, no complications occurred. Postoperatively, the average hospital stay was 1.1 days. The stents were removed at an average of 20 days (range 14 to 28) postoperatively. The average follow-up was 11.7 months; at the last follow-up visit, each patient was doing well. Of the 50 patients, 48 underwent one or more renograms, demonstrating stable renal function, improved drainage, and no evidence of recurrent obstruction. Conclusions. Robotic-assisted laparoscopic pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. The procedure provides a minimally invasive alternative with good short-term results. UROLOGY 66: 45–49, 2005. © 2005 Elsevier Inc. L aparoscopic pyeloplasty has now been per- formed successfully for more than a decade. Since its infancy in the early 1990s, the technique has evolved significantly and is now a procedure that shows comparable efficacy to that of the open surgical approach. 1–10 Although the benefits of minimally invasive surgery are attractive, the uni- versal acceptance of this procedure by urologists has been slow owing to the formidable learning curve. Some of the difficulty associated with lapa- roscopic pyeloplasty is attributable to the limita- tions imposed by conventional laparoscopic in- strumentation and the surgeon’s proficiency with it. The introduction of robotic technology into modern day operating rooms has helped to reduce some of the limitations imposed by the straight laparoscopic approach. 11 The most commonly used robot is the da Vinci robotic system (Intuitive Surgical, Sunnyvale, Calif). The robot provides magnified three-dimensional vision, tremor filter- ing, motion scaling, and an articulating robotic En- dowrist with six degrees of freedom. Theoretically, this should be advantageous with laparoscopic re- constructive procedures that require intracorpo- real suturing. We evaluated the efficacy and feasi- bility of robotic-assisted laparoscopic pyeloplasty. MATERIAL AND METHODS Between July 2002 and October 2004, 50 patients, 30 males and 20 females (mean age 31 years, range 16 to 62) underwent pyeloplasty by a single surgeon (V.R.P.). The initial diagnosis was precipitated by renal colic in 33 patients and was found incidentally in 17 patients during workup of other nonrelated medical disorders. The diagnosis was confirmed by either in- From the Department of Minimally Invasive Surgery, Urology Centers of Alabama, Vestavia Hills, Alabama Reprint requests: Vipul Patel, M.D., Division of Urology, The Ohio State University, 558 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210. E-mail: vpatel2171@aol.com Submitted: October 5, 2004, accepted (with revisions): January 26, 2005 ADULT UROLOGY © 2005 ELSEVIER INC. 0090-4295/05/$30.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.01.053 45