Functional outcomes after pure laparoscopic or robot-assisted pyeloplasty

The management of ureteropelvic junction obstruction (UPJ) has evolved over the past 20 years in response to development of new technology. Open surgery continues to be the reference standard so far, against which all other surgical modifications must be measured. The surgical approach has, however, gone through rapid changes, and the open procedure initially described has evolved considerably in the last two decades. Endoscopic and laparoscopic approaches have largely supplanted open pyeloplasty for the majority of primary ureteropelvic junction obstruction cases. Laparoscopic approaches provide a balance between a highly successful technique in all patients and improved postoperative recovery. It has been shown to improve postoperative outcomes with shorter recovery times and hospital stays and to provide equivalent functional results with a success rate of 95%. Nevertheless, laparoscopic pyeloplasty is not a simple procedure. There is certain number of disadvantages such as limited range of laparoscopic instrument movement, the two dimensional image, the unfamiliar hand-eye coordination and the relatively inefficient ergonomic position. From 2000, the robot has offered a magnified three-dimensional vision associated with a greater degree of freedom. This system has simplified suturing and has improved precision of the operative technique. Despite the financial cost, it seems easier for beginners to learn the robotic technique if the system is available in their institution, presenting similar success rates (radiological and clinical) to those obtained with open techniques. (C) 2009 AEU. Published by Elsevier Espana, S.L. All rights reserved.