Robot-assisted, single-site, dismembered pyeloplasty for ureteropelvic junction obstruction with the new da Vinci platform: a stage 2a study

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.