Robotic pyeloplasty: trans- and retro-peritoneal approach.

Introduction & Objectives: Robotic pyeloplasty can be performed either retroperitoneally or transperitoneally. In this video we show our technique of pyeloplasty for both approaches. Materials & Methods: In first case we preferred the transperitoneal approach because there was a big redundant renal pelvis in a thin patient. We incised the peritoneum and exposed the pelvis and the ureter. The stenotic junction is transected. The ureter is spatulated and an Anderson-Hynes pyeloplasty is performed using a 4-0 vicryl stitch. In second case the renal pelvis was small. We preferred not to enter the peritoneum and to adopt a retroperitoneal approach. The Psoas muscle is identified. The Gerota’s fascia is incised. The ureteropelvic junction is dissected an the pyeloplasty is performed. Results: Operative time was 90 minutes and 110 minutes for the transperitoneal and retroperitoneal approach respectively. We had no intraoperative complications. Postoperative stay was easy and uncomplicated. Both patients removed the double J stent three weeks after surgery. At three months postop. the ultrasonography was normal. Conclusions: robotic pyeloplasty can be performed successfully either transperitoneally or retroperitoneally. We believe that the transperitoneal approach must be preferred in case of a large redundant pelvis because it offers the surgeon a larger working space and because it makes easy to identify the renal pelvis. Retroperitoneal approach is more appropriate in case of relatively small renal pelvis.