title: Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis.
abstract: BACKGROUND
  Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized.
  
  
  OBJECTIVE
  To critically analyze the current status of laparoscopic and robotic repair of UPJO.
  
  
  METHODS
  A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria.
  
  
  RESULTS
  Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population.
  
  
  CONCLUSIONS
  Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy. Electronic address: ricautor@tin.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Department of Urology, Royal Surrey County Hospital, Guildford, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Eden
authors.affiliation: Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France.
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Ghoneimi
authors.affiliation: Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy.
authors.forename: Nicolòmaria
authors.initials: N
authors.lastname: Buffi
authors.affiliation: Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Peters
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Gettman
mesh_terms: D016009:Chi-Square Distribution; D006801:Humans; D007682:Kidney Pelvis / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D016017:Odds Ratio; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Laparoscopy; Pyeloplasty; Robot-assisted; Ureteropelvic junction obstruction