title: Retroperitoneal and transperitoneal robot-assisted pyeloplasty in adults: techniques and results.
abstract: BACKGROUND
  The surgical management of ureteropelvic junction obstruction (UPJO) has dramatically evolved over the past 20 yr due to the development of new technology.
  
  
  OBJECTIVE
  Our aim was to report the feasibility and efficacy of robot-assisted pyeloplasty (RAP) performed by either the retroperitoneal or the transperitoneal approach.
  
  
  METHODS
  A stage 2 investigative study was conducted including development (stage 2a) and exploration (stage 2b) of transperitoneal and retroperitoneal RAP performed in 55 patients at an urban tertiary university department of urology.
  
  
  METHODS
  Retroperitoneal RAP was performed with the patient in full flank position using a 12-mm Hasson-style optical port at the tip of the 12th rib, plus two operative 8-mm robotic trocars and an assistant 5-mm port. The stenotic ureteropelvic junction was excised, the ureter was spatulated, and a dismembered pyeloplasty was performed in all cases. Transperitoneal RAP was performed with the patients in the 60° flank position. The optical port is in the umbilical area, plus two 8-mm operative robotic ports and one 5-mm assistant port. The pyeloplasty technique is similar to the retroperitoneoscopic approach. In both groups, the stent can be positioned in an anterograde or retrograde fashion.
  
  
  METHODS
  Success consisted of no evidence of obstruction on computed tomography urography or mercaptoacetyltriglycine-3 diuretic renal scan, no postoperative symptoms, and no further treatment.
  
  
  CONCLUSIONS
  Thirty-six patients underwent retroperitoneoscopic RAP and 19 transperitoneal RAP for UPJO. All the procedures were completed with robotic assistance. The overall objective success (measured by diuretic renal scan and/or imaging techniques) was 96% with two cases of recurrence (both in the retroperitoneal group). The main limitation was the short follow-up, although all patients reached at least a 6-mo follow-up.
  
  
  CONCLUSIONS
  RAP performed either retroperitoneally or transperitoneally was revealed as a feasible and reproducible surgical option for the treatment of UPJO, offering a subjective optimal plasty reconfiguration at short follow-up.
authors.affiliation: Department of Urology, Vita-Salute University, San Raffaele Hospital-Turro, Milan, Italy. a_cestari@yahoo.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Cestari
authors.forename: Nicolò Maria
authors.initials: NM
authors.lastname: Buffi
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lista
authors.forename: Mattia
authors.initials: M
authors.lastname: Sangalli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Scapaticci
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbri
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods; D010537:Peritoneum / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D012187:Retroperitoneal Space / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult