Schwentner C et al. (2007) Robotic Anderson–Hynes pyeloplasty: 5-year experience of one center. BJU Int 100: 880–885

Laparoscopic pyeloplasty is currently the reference standard technique for the treatment of pelvi-ureteric junction obstruction (PUJO); however, the increased difficulty and training required for the laparoscopic procedure compared with open surgery has impeded its widespread adoption. Schwentner and colleagues have described their 5-year experience with robotically assisted laparoscopic pyeloplasty (RALP), a technique that is reportedly easier and quicker to learn than standard laparoscopy.

Between 2001 and 2006, 92 patients (mean age 25.13 years, range 14–74) with either primary (n = 80) or secondary (n = 12) PUJO underwent transperitoneal RALP using the da Vinci® robot system (Intuitive Surgical, Sunnyvale, CA). The dismembered Anderson–Hynes protocol was used in all patients. The mean follow-up period was 39.1 months (range 3–73 months).

Overall, the procedure was successful in 89 (96.7%) of 92 patients, with only three patients requiring additional surgery to resolve their PUJO. The mean operative time was 108.3 min (range 72–215 min), and shortened significantly as the surgeons gained experience of the procedure (mean duration 137.4 min for the first 12 operations versus 89.76 min for the last 12 operations, P = 0.001). There were no intraoperative complications, and no conversions to open surgery. The mean hospital stay was 4.6 days (range 3–11 days), and there were no cases of late failure during follow-up.

The authors conclude that, despite some disadvantages with RALP (for example the considerable cost of the robot), this procedure is safe, feasible and easy to learn, with excellent success rates and low rate of postoperative complications.