title: Robotic laparoscopic pyeloplasty.
abstract: OBJECTIVE
  We aimed to assess the feasibility and outcomes of complex ureteropelvic junction obstruction cases submitted to robotic-assisted laparoscopic pyeloplasty.
  
  
  METHODS
  The records of 131 consecutive patients who underwent robotic-assisted laparoscopic pyeloplasty were reviewed. Of this initial population of cases, 17 were considered complex, consisting of either atypical anatomy (horseshoe kidneys in 3 patients) or previous ureteropelvic junction obstruction management (14 patients). The patients were divided into 2 groups: primary pyeloplasty (group 1) and complex cases (group 2).
  
  
  RESULTS
  The mean operative time was 117.3 ± 33.5 minutes in group 1 and 153.5 ± 31.1 minutes in group 2 (P = .002). The median hospital stay was 5.19 ± 1.66 days in group 1 and 5.90 ± 2.33 days in group 2 (P = .326). The surgical findings included 53 crossing vessels in group 1 and 5 in group 2. One patient in group 1 required conversion to open surgery because of technical difficulties. One patient in group 2, with a history of hemorrhagic rectocolitis, presented with peritonitis postoperatively due to a small colonic injury. A secondary procedure was performed after the patient had an uneventful recovery. At 3 months, significant improvement (clinical and radiologic) was present in 93% of cases in group 1 and 88.2% in group 2. At 1 year, all patients in group 2 showed satisfactory results. At a late follow-up visit, 1 patient in group 1 presented with a recurrent obstruction.
  
  
  CONCLUSIONS
  Robotic pyeloplasty appear to be feasible and effective, showing a consistent success rate even in complex situations. Particular care should be observed during the colon dissection in patients with previous colonic pathology.
authors.affiliation: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil. mariochammas@usp.br.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Chammas
authors.affiliation: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Anuar I
authors.initials: AI
authors.lastname: Mitre
authors.affiliation: Department of Urology, University Henri Poincare/CHU Nancy, Vandoeuvre-lèsNancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hubert
authors.affiliation: Department of Urology, University Henri Poincare/CHU Nancy, Vandoeuvre-lèsNancy, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Egrot
authors.affiliation: Department of Urology, University Henri Poincare/CHU Nancy, Vandoeuvre-lèsNancy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Hubert
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*