Adult Robotic Pyeloplasty

Surgical approach to the management of ureteropelvic junction (UPJ) obstruction (UPJO) has evolved significantly over the last three decades, with the increasing adoption of minimally invasive approaches: ureteroscopy and nephroscopy since the early 1980s, laparoscopic since 1993, and robotic since 2001 versus the historical gold standard of open surgical pyeloplasty. A range of currently available options include endoscopic endopyelotomy and open surgical, laparoscopic, and robotic pyeloplasty. Regardless of the options available, the surgeon can consider different techniques and choose transmesenteric, retroperitoneal, dismembered, reduction pyeloplasty with or without transposition of collecting system around crossing vessels, etc. Interestingly, despite the steep learning curve and perceived challenges of performing open surgical pyeloplasty and with increasing adoption of minimally invasive approaches with comparable success and complication rates, open surgical pyeloplasty remains the interventional gold standard treatment option for UPJO, worldwide.