Robot-assisted laparoscopic pyeloplasty: current status and future directions

Abstract

Ureteropelvic junction obstruction is an impairment of urine flow across the ureteropelvic junction and warrants surgical treatment (pyeloplasty) when clinically significant. Pyeloplasty techniques have undergone significant evolution over time, but dismembered pyeloplasty remains the gold standard for treatment, offering excellent success rate and durable results coupled with low complications. With the advent of minimally invasive surgery (MIS), dismembered pyeloplasty has been performed via MIS since the 1990s, and currently more than half of all pyeloplasties are done in this manner in the US. MIS pyeloplasty has proven benefits that include smaller incisions, shorter hospital stay, reduced blood loss, and less postoperative analgesic requirement. Robot-assisted laparoscopic pyeloplasty (RLP) adds a shorter operative time, elimination of surgeon's hand tremor, and likely a shorter surgeon learning curve by providing wristed instruments and better vision for easier suturing. However, studies have shown RLP to be costlier, which can be ameliorated by higher patient throughput, minimizing surgeon learning curve, and possible future availability of other robotic systems, leading to competition and cost reduction. State-of-the-art robotic surgical developments include single-incision surgery, for which different options are currently available and more are being developed. These efforts will likely lead to development and popularization of new dedicated robotic single-site surgical platforms and solitary intracorporeal stems with deployable camera and instruments. These technological advances will inevitably be incorporated into pyeloplasty, resulting in reduced costs and availability of more surgical options in this area.