Reconstructive Urological Procedures Research Articles

Intracorporeal Antegrade and Retrograde Stenting During Robot-Assisted Urinary Tract Reconstruction: Is It the Ideal Choice?

Introduction and Objective: One of the pertinent steps in many urologic reconstructive procedures is the placement of a stent across the repair. With regard to upper urinary tract reconstruction, many surgeons perform this step cystoscopically and place the stent in a retrograde fashion. Herein, we present our simplified, efficient, and cost-saving technique of Double-J (JJ) stent placement intracorporeally during robot-assisted upper urinary tract reconstructive surgery. Methods: With Institutional Review Board's approval, we queried our database of robotic procedures to identify those reconstructive operations that involved intracorporeal JJ stent placement since 2008. We describe our step-by-step technique for intracorporeal JJ stent placement during robot-assisted pyeloplasty, pyelolithotomy, and upper, mid, and lower ureteral reconstructive surgeries. Briefly, the floppy tip of a guide wire is passed through the open end of the JJ stent until it straightens out the stent. After a certain amount of the reconstruction has been performed, the stent is advanced intracorporeally through the assistant port. The console surgeon utilizes the robotic instruments to manipulate the stent into the ureter or other desired location. Once the stent has been adequately placed, it is stabilized with the robotic instruments while the guide wire is removed. A variety of techniques are employed for specific reconstructions to manipulate the stent into the desired position. Results: In the last 3 years, we have used this approach in 150 patients. Mean time of insertion was ∼3.5 minutes. In 3 patients, postoperative kidney, ureter, and bladder radiograph demonstrated that the stent had migrated proximally into the ureter. As these patients did not have any discomfort and the stent still spanned across the reconstructed anastomosis, we chose not to reposition the stent. In these 3 patients, the stent was removed ureteroscopically at the appropriate time, without any sequela. Conclusions: The described intracorporeal stenting technique during robotic urologic reconstructive procedures is efficient, cost-effective, and relatively simple to master. There is no need for patient repositioning, cystoscopy, or fluoroscopy, thereby avoiding increased operative time, cost, and radiation exposure. In upper tract robotic reconstructive surgery, intracorporeal JJ stenting should be the ideal choice. No competing financial interests exist. Runtime of video: 6 mins 27 secs

V874 INCISIONLESS DUAL DIVERSIONS CREATION OF UROSTOMY AND COLOSTOMY USING THE DA VINCI ROBOT

Abstract Introduction and Objective: With the introduction of the Da Vinci robotic system (Intuitive Surgical Inc.), many urological reconstructive procedures have been performed through this minim...

V875 REPAIR OF VESICO-UTERINE FISTULA BY SINGLE INCISION LAPAROSCOPIC SURGERY

You have accessJournal of UrologyOncology (TCC & Adrenal) & Teaching Techniques1 Apr 2012V875 REPAIR OF VESICO-UTERINE FISTULA BY SINGLE INCISION LAPAROSCOPIC SURGERY Rajinder Yadav, Manish Kulshreshtha, Nitin Sharma, and Vipul Agrawal Rajinder YadavRajinder Yadav New Delhi, India More articles by this author , Manish KulshreshthaManish Kulshreshtha New Delhi, India More articles by this author , Nitin SharmaNitin Sharma New Delhi, India More articles by this author , and Vipul AgrawalVipul Agrawal New Delhi, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the first laparoscopic surgery in urology in 1990s, it has been used for treatment of a variety of urologic disorders. The benefits are well recognized & known to everyone. A number of papers & case series have been published on Single Incision Laparoscopic Surgery (SILS) extirpative surgery, especially nephrectomy. Applicaltion of SILS for management of complications of previous surgery is limited to occasional case reports. We present a case of 38 yr female with Vesicouterine fistula following complicated Caesarian Section. Fistula was associated with bilateral vesicoureteric reflux with Rt nonfunctioning kidney, managed by SILS repair of fistula with subtotal hysterectomy & Rt nephro-ureterectomy. METHODS With patients in lithotomy, Lt side was stented as fistula was close to Lt ureteric orifice. After a 2cm periumblical incision was taken, a Size 7 surgical glove was inserted. Three 5mm ports were introduced through the fingers of the glove. The procedure was carried out using laparoscopic working instruments, scope & camera. After identifying the fistula tract, subtotal hysterectomy and closure of cervix was done. This was followed by repair of fistula and omental transposition. Then pt was taken in 70o lateral position for Rt nephro-ureterectomy. We required a rescue port during fistula repair, which was later used for keeping drain. RESULTS The duration of surgery was 320 min. The blood loss was 100ml. No blood transfusion was required. The drain was removed on POD3. She was in hospital for 5 days. Foleys was removed after 6 wks and stent removed after 3 months. CONCLUSIONS Single Incision Laparoscopic Surgery (SILS) is an emerging sub-specialty of Lap-urology gaining acceptance & popularity very quickly. Till date, publications have shown acceptable results of SILS in urology, which are comparable to standard laparoscopic surgery. SILS techniques are still in the early stages of development and additional studies with larger cohorts are required to more accurately determine its role in the field of urologic surgery. Further technological advances with regards to instrumentation and retraction should facilitate implementation of this surgical platform, especially in management of complicated cases like genito-urinary fistulas. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e356 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajinder Yadav New Delhi, India More articles by this author Manish Kulshreshtha New Delhi, India More articles by this author Nitin Sharma New Delhi, India More articles by this author Vipul Agrawal New Delhi, India More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Robotic urologic reconstructive procedures

This review provides an overview of reconstructive robotic procedures in urology. Recently, robotic surgeons have described techniques in urologic reconstruction. We summarize the literature regarding outcomes and surgical steps for robotic pyeloplasty, robotic ureteral neocystostomy with ureteral reimplantation and robotic ureteroureterostomy/ureterolithotomy. Outcomes reveal robotic assistance has greatly decreased the morbidity of urinary tract reconstruction, when compared with open surgical techniques. In addition, the superior visual and manual acuity of the robot allows one to perform surgical steps easier as compared with conventional laparoscopy. Robotic assistance provides many benefits for urinary tract reconstruction and in this review we outline the salient features, with the goal of adding these techniques to the urology armamentarium. Future outcome studies need to confirm the long-term efficacy of these techniques.

Robotic-assisted reconstructive urology

The use of robotic surgery in reconstructive urology has steadily increased since the year 2000. Articles in the MEDLINE database (from January 2000 to May 2011) identified using the Boolean search: robotic or robot-assisted and reconstructive surgery and urology. In addition, the reference lists of previously published articles on robotic-assisted reconstructive surgery were checked for additional studies. This review will summarize the current advances in robotic-assisted reconstructive urology. Even though many advocate the introduction of robot-assisted technique in reconstructive urology, relatively few studies have been published. Researchers do report shorter hospital stays and less blood loss than are reported for patients operated on with open reconstructive techniques and also report acceptable short-term outcomes. The current literature shows that complex robot-assisted urological reconstructive surgical procedures may be used for both children and adults. With appropriate experience, this technique offers the expected advantages of decreased blood loss and transfusion rate, reduced analgesic requirements, and early hospital discharge in comparison with the open approach. However, robotic-assisted reconstructive urologic surgery needs to be evaluated in larger randomized studies with long-term follow-up.

VID-04.05 A Novel Intracorporeal Knotting Technique for Laparoendoscopic Surgery

Laparoendoscopic Single Site (LESS) urological procedures aregaining popularity across the globe. Most reported series/case reports of reconstructive LESS urological procedures such as partial nephrectomy and pyeloplasty describe the use of an additional port (2-5mm) to aid dissection and to accomplish an intra-corporeal knot. We will demonstrate with this high-definition video, a step-by-step guide to achieve complete intra-corporeal knotting technique on the box trainer and subsequently the application of this technique to complex urological reconstructive procedures, in this case of laparoscopic partial nephrectomy.

Robotic reconstructive urology: possibilities for the urological surgeon beyond the prostate

AbstractThe rapid dissemination of robotic‐assisted laparoscopic surgery into surgical practice over the past five years has been startling. Urology has been quick to develop robotic‐assisted techniques, particularly in the treatment of localised prostate cancer, where large series with excellent outcomes have been reported. The UK currently has 23 da Vinci (Intuitive Surgical, Sunnyvale, CA, USA) surgical systems, with several more planned, and most are primarily used to perform robotic‐assisted radical prostatectomy (RARP). However, there are a growing number of other reconstructive urological procedures facilitated by this robotic system, which, although less numerous and thus potentially less financially rewarding than RARP, may also have huge patient benefits.

En bloc urinary bladder resection for locally advanced colorectal cancer: a 17-year experience

En bloc bladder resection is often required for treating colorectal cancer with suspected urinary bladder invasion. Our aim was to review our institutional experience in en bloc resection of locally advanced colorectal cancer involving the urinary bladder over a period of 17 years. The hospital records of 72 patients with locally advanced colorectal cancer who underwent en bloc urinary bladder resection at our institution between July 1987 and December 2004 were retrospectively reviewed. Clinical and oncologic outcomes were evaluated. The mean duration of follow-up was 64.3 months. Genuine tumor invasion into the urinary bladder was confirmed in 34 patients (47%) by histopathology. Forty patients (56%) underwent primary closure of the urinary bladder, while 32 patients (44%) required various kinds of urologic reconstructive procedures. Operative mortality occurred in four patients (6%). The overall postoperative morbidity rate was significantly higher in patients undergoing urologic reconstruction (81% vs. 45%, p = 0.002) when compared to that in patients undergoing primary closure. This was mostly attributable to significantly higher rates of urinary anastomotic leak (21.9% vs. 0%, p = 0.002) and urinary tract infection (50% vs. 18%, p = 0.003) in the urologic reconstruction group. For the 57 patients (79%) who underwent curative resection, the 5-year overall survival rate was 59%, and the local recurrence at 5 years was 15%. Both parameters were not significantly affected by the presence of pathologic bladder invasion or the extent of surgical procedures. En bloc bladder resection for locally advanced colorectal cancer involving the urinary bladder can produce reasonable long-term local control and patient survival.

Development of late, symptomatic abdominopelvic lymphoceles more than 10 years following pediatric reconstructive urologic procedures

Purpose Rare reports of symptomatic abdominopelvic lymphoceles following pediatric genitourinary reconstruction do exist; however there are no data regarding the development or management of late symptomatic lymphoceles. We report on the clinical presentation of these lymphoceles 10 or more years following initial urologic surgery. Materials and Methods We reviewed 480 patients following major intra-abdominal urologic reconstructive procedures from 1986 to 2009 for development of late, symptomatic abdominopelvic lymphoceles. A minimum of 10 years post-surgical follow up was required for inclusion. Results Late symptomatic lymphoceles developed in 4/480 (0.8%) patients. Median length of follow up post reconstruction was 13.5 years (range 10–17). Median time to lymphocele development was 12 years (range 8–16). Symptoms at presentation included abdominal distension (4/4, 100%), nausea and vomiting (3/4, 75%), flank pain/progressive hydroureteronephrosis (3/4, 75%), and obstructive pyelonephritis (1/4, 25%). Additional surgical procedures that may have contributed to lymphocele development were present in 100%. 75% (3/4) of the patients underwent open surgical drainage, with one electing observation for intermittent symptoms. Exploration revealed loculated fluid collections between bowel loops and dense adhesions; symptoms resolved although small asymptomatic recurrences developed in all patients. Conclusions Late, symptomatic abdominopelvic lymphoceles following major pediatric urinary tract reconstruction or diversion develop in <1% patients. Many undergo subsequent abdominopelvic surgery, which may contribute to development of these late, pathologic lymphoceles. Open surgical drainage is usually required with excellent outcome.

V495 NAVIGATING THE DIFFICULT ROBOTIC PYELOPLASTY: TIPS AND TRICKS

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V495 NAVIGATING THE DIFFICULT ROBOTIC PYELOPLASTY: TIPS AND TRICKS David Thiel and Alex Rogers David ThielDavid Thiel Jackosnville, FL More articles by this author and Alex RogersAlex Rogers Jacksonville, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.591AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urology has adopted the da Vinci surgical system (Intuitive Surgical Corp, Sunnyvale, CA) for robotic assisted laparoscopic prostatectomy. Use of the technology has been expanded to other complex reconstructive urologic procedures such as pyeloplasty. Robotic assisted pyeloplasty (RAP) is being performed by many surgeons without prior laparoscopic experience. Difficult situations encountered intra-operatively can increase operating room time, increase morbidity, and decrease the success of RAP. METHODS Patient selection, port placement, ureteropelvic junction obstruction (UPJO) exposure, UPJO excision and repair are reviewed and tips given to circumvent difficult situations encountered during RAP. The video demonstrates techniques to aid in cases of extreme obesity, a large floppy liver, difficult to reflect colon (trans-mesenteric pyeloplasty), crossing vessels, large calculi, and previous attempts at UPJO repair. RESULTS Techniques to aid in successful completion of RAP in the face of extreme obesity, a large floppy liver, difficult to reflect colon (trans-mesenteric pyeloplasty), crossing vessels, large calculi, and previous attempts at UPJO repair are demonstrated. CONCLUSIONS This video demonstrates tips to aid in successful completion of UPJO repair in the face of difficult situations commonly encountered during surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e202 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Thiel Jackosnville, FL More articles by this author Alex Rogers Jacksonville, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1051 PERI-OPERATIVE MORBIDITY RELATED TO BOWEL PREPARATION BEFORE ILEAL USE FOR LOWER URINARY TRACT RECONSTRUCTIVE PROCEDURES: A RANDOMIZED PROSPECTIVE STUDY

Bowel preparation is routine before large bowel use for reconstructive urological procedures. However, surgeons may finally resort to small bowel use. In these situations, added morbidity of the unnecessary bowel preparation has been questioned. This study prospectively evaluates the peri-operative morbidity added by bowel preparation before ileal reconstructive procedures of the lower urinary tract. Forty patients were prepared for ileal urinary diversion after getting informed consent. They were prospectively randomized into 2 groups. Group (I) was subjected to standard 3days bowel preparation (using laxatives, enemas and antibiotics)1. Group (II) was subjected to over-night fasting before surgery. Preand post-operative complete laboratory workup including: complete blood counts, serum electrolytes levels, kidney & liver function tests. A 1 ml of ileal secretions was collected intra-operatively for aerobic and anaerobic cultures. Bacterial overgrowth is diagnosed when the number of bacterial colonies cultured exceeds 105 /mL fluid in the small intestine2. A tissue specimen from the ileum was sent for histopathology. Post-operative complications concerning wound and tissue healing were reported.

ROBOTIC RECONSTRUCTIVE UROLOGY: POSSIBILITIES FOR THE UROLOGICAL SURGEON BEYOND THE PROSTATE

The rapid dissemination of robotic-assisted laparoscopic surgery into surgical practice over the past five years has been startling. Urology has been quick to develop robotic-assisted techniques, particularly in the treatment of localised prostate cancer, where large series with excellent outcomes have been reported. The UK currently has 23 da Vinci (Intuitive Surgical, Sunnyvale, CA, USA) surgical systems, with several more planned, and most are primarily used to perform robotic-assisted radical prostatectomy (RARP). However, there are a growing number of other reconstructive urological procedures facilitated by this robotic system, which, although less numerous and thus potentially less financially rewarding than RARP, may also have huge patient benefits.

Laparoendoscopic single-site surgery in urology

To analyze the current literature regarding advances in laparoscopic single-site (LESS) surgery in urology. Since its initial urologic description in 2007, there has been a surge of interest in LESS surgery. Published descriptions of LESS procedures now include virtually all extirpative and reconstructive urologic procedures. Novel instrumentation and techniques have been developed that offset many of the inherent increased technical demands with LESS surgery. Substantial clinical data have recently been reported that attest to the safety and efficacy of LESS surgery in select patients. Initial data have also been reported comparing morbidity outcomes with standard laparoscopy. LESS is now an established technique within the field of minimally invasive urologic surgery. Further study is needed to determine the true benefits of the technique and the extent of its clinical application. Further refinements in technology will likely be needed before the widespread adoption of LESS.

Urine Derived Cells are a Potential Source for Urological Tissue Reconstruction

Contemporary approaches to tissue engineering and cell therapy for urinary tract reconstruction require invasive tissue biopsies to obtain autologous cells. However, these procedures are associated with potential complications. We determined whether the cells present in urine have characteristics of normal bladder cells and investigated their potential uses for urological reconstructive procedures. A total of 55 urine samples were collected from 15 healthy individuals and 8 patients with vesicoureteral reflux. Urine derived cells were isolated, expanded and tested for progenitor and differentiated cell specific markers using flow cytometry, immunofluorescence and Western immunoblotting. The chromosomal stability of cultured urine derived cells was determined by karyotype analysis. Clones were successfully established from primary cultures of urine derived cells. Isolated cells showed 3 phenotypes, including fully differentiated, differentiating and progenitor-like cells. Some urine derived cells stained positive for the surface markers c-Kit, SSEA4, CD105, CD73, CD91, CD133 and CD44. Two to 7 cells per 100 ml urine were multipoint progenitors that could expand extensively in culture. Single progenitor cells had the ability to differentiate into the cell lineages expressing urothelial, smooth muscle, endothelial and interstitial cell markers. The expression of lineage markers was characterized by Western blot and immunofluorescence analysis. Urine derived cells also maintained a normal karyotype after serial culture. A subpopulation of cells isolated from urine had progenitor cell features and the potential to differentiate into several bladder cell lineages. Urine derived cells could serve as an alternative cell source for urinary tract tissue engineering and reconstruction.

LapED® 4-In-1 Silicone Training Aid for Practicing Laparoscopic Skills and Tasks: A Preliminary Evaluation

We developed a simple, inexpensive model to simulate four reconstructive laparoscopic procedures: pyeloplasty, vesicourethral anastomosis, bladder injury repair, and partial nephrectomy. Liquid silicone was applied in layers to a mold to create the 4-in-1 model. A questionnaire evaluating its face and content validity was distributed to postgraduate urologists participating in a mini-residency program at the University of California-Irvine (UCI), and in the 2006 American Urological Association Hands-On course on reconstructive laparoscopic pyeloplasty. A total of 56 postgraduate urologists used the model and completed an evaluation questionnaire. Ninety-four percent (51/54) and 96% (48/50) agreed that the model was helpful for practicing laparoscopic pyeloplasty and urethrovesical anastomosis, respectively. Urologists who were experienced in either performing laparoscopic pyeloplasty (n = 6) or robot-assisted and/or laparoscopic prostatectomy (n = 11) would recommend this model to surgeons in training. Overall, 94% (48/51) and 96% (50/52) of the respondents would recommend this model for postgraduate surgeons and residents, respectively. We present a versatile model for practicing laparoscopic and robotic suturing and knot-tying skills in four reconstructive urologic procedures. Our results support the face and content validity of this model for performing pyeloplasty and vesicourethral anastomoses.

POS-02.133: Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: A multi-institutional multinational evaluation of 13 cases

The use of robotics in complex urologic reconstructive procedures is increasing. We report the experience of three multinational institutions using robotics to treat complex distal ureteral disease.

Laparoscopic Pyeloureterostomy: Experience in Three Cases

To report our experience with transperitoneal laparoscopic pyeloureterostomy for duplication of the collecting system. Since January 2003, two adult patients with incomplete duplication of ureter with ureteropelvic junction obstruction of the lower moiety and a 4-month-old male baby with complete duplication of the ureter with reflux in the lower moiety underwent transperitoneal laparoscopic pyeloureterostomy. The baby also had excision of the lower-moiety ureter. There was no significant intraoperative or postoperative morbidity. Follow-up imaging revealed good drainage. With increasing experience in laparoscopic reconstructive urologic procedures, laparoscopic pyeloureterostomy is a feasible option, even in infants.

Use of the Mitrofanoff principle in urinary tract reconstruction: Experience with 122 children

<b>Purpose: </b> Use of the Mitrofanoff principle is a valuable adjunct to many reconstructive urological procedures in the pediatric age group requiring clean intermittent catheterization (CIC) especially if the urethra is not easily catheterizable. We present our experience with 122 children and analyze the results of this operation. <br><b> Materials and Methods: </b> 133 Mitrofanoff channels (100 appendicular, 31 ureteric and 2 Monti) were constructed in 122 children (93 boys and 29 girls) of mean age 6.3 years over the period from 1997 to 2005. The procedure was part of the reconstructive procedure in patients of neurogenic bladder (n=44), exstrophy-epispadias (n=40), posterior Urethral valve (n=30), and other diseases (n=8). Additional procedures included augmentation cystoplasty (n=90) and bladder neck procedure (n=46).<br><b> Results: </b> Mean follow-up was 2.6 years in 109 patients. Overall results were satisfactory. Major complication rates with the Mitrofanoff conduit using appendicular and ureteric channels were 7.4 % in and 25.8%, respectively, most of the ureteric channels due to non-use, there being alternate channels for catheterization. Only six (4.5%) children required re-operation for significant problems with the Mitrofanoff conduit: revision of stoma due to stenosis or kinking (n=4) and closure of stoma due to troublesome leak (n=2). Children and parents were satisfied with the results of the operation and the majority was compliant with regular CIC. All children were socially well accepted and those above 6 years of age were attending regular school. <br><b> Conclusions: </b> The Mitrofanoff procedure is a feasible and acceptable option, with a low complication rate, for use as part of complex urinary reconstruction in a developing country. Patient education, family motivation, and cost reduction are important factors for success.

SIMPLIFIED MONS PLASTY: A NEW TECHNIQUE TO IMPROVE COSMESIS IN FEMALES WITH THE EXSTROPHY-EPISPADIAS COMPLEX

Long-term data suggest that a significant number of women with the exstrophy-epispadias complex (EEC) report dissatisfaction with the cosmetic appearance of the genitalia. We developed a new technique of mons plasty in an attempt to improve the overall cosmetic appearance of the external genitalia in females with EEC. Nine consecutive females with a mean age of 6.4 years (range 2 days to 12.2 years) previously diagnosed with EEC underwent simplified mons plasty concomitantly with various other urological reconstructive procedures. Briefly, a simplified mons plasty was performed by approximating the bifid hemiclitoris and subsequently incising the lateral sulci between the labia majora and minora, which allowed the superomedial rotation of the labia majora and underlying peripubic adipose tissue, thus, recreating the mons. There were no perioperative complications. With a mean followup of 6 months (range 4 to 12) all patients had improved cosmesis with respect to a more prominent mons, more appropriately situated labia and adequately recessed introitus. Simplified mons plasty improves cosmesis in females with external genital abnormalities secondary to EEC. Although our followup is admittedly short, we believe that this technique should be considered in the armamentarium of the reconstructive surgeon during the operative treatment of this complex group of patients.

Robotic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction.

Objective: Laparoscopic pyeloplasty has been shown to have equivalent surgical outcomes with less surgical morbidity when compared to the open approach. The laparoscopic approach has traditionally been performed in a few specialized training centers because of the advanced technical skills required to perform this complex reconstructive procedure. The introduction of robotic technology into the modern day operating suite has brought on a new era and has simplified complex urologic reconstructive procedures. The daVinci robot provides the advantages of three-dimensional vision, magnification, and a robotic articulating wrist. These features allow precise dissection and suturing capabilities. We used the daVinci robot to perform robotic assisted laparoscopic pyeloplasty. We studied its feasibility, utility, and efficacy. Methods: Between July 2002 and April 2003, 12 patients with a mean age of 29.2 years (16-56) underwent robotic assisted laparoscopic dismembered pyeloplasty. Each patient had presented with flank pain (six left and right) and had been diagnosed with a ureteropelvic junction (UPJ) obstruction by either IVP or MAG3 renal scan. A retrograde pyelogram was performed preoperatively to delineate the anatomy and a stent was placed. Robotic dismembered pyeloplasty was performed. Eight of 12 patients had crossing vessels only five of which were shown on preoperative CT scan. The crossing vessels were preserved in all cases. The UPJ was dismembered at the point of obstruction and the scar excised. The ureter was spatulated medially and the renal pelvis fashioned appropriately. Ureteropelvic reconstruction was performed with eight-interrupted 4-0 monocryl sutures on an RB-1 needle in the first five cases. In the other seven cases the anastomosis was performed with two running semicircular sutures. Stents were removed at 14-28 days. An IVP was performed prior to stent removal and a renal scan at 3 and 6 months. Results: Each patient underwent a successful procedure without open conversion, transfusion or complication. Estimated blood loss was minimal at 52 cm3. Each patient was discharged home on the first postoperative day, average 18 h. Operative times fell quickly as experience with the daVinci robot increased. Operative time averaged 201 min. The first five patient's average or time was 262 vs. 158 min for the last seven. Time for the anastomosis averaged 42 min (100-20). The initial five cases were performed with an interrupted anastomosis. These took longer averaging 65.4 min (100-33). The subsequent seven cases were performed with two running hemi-circumferential stitches with anastomotic time averaging 25 min (30-20). Intraoperatively no complications were noted. Postoperatively the average hospital stay measured from the time of surgery to the time of discharge averaged 18 h (24-16). No postoperative complications have been noted. Average return to work is 10.9 days, and clearance for full activity at 17 days. Duration of the stent has averaged 18 days (24-13). The initial five patients with the interrupted anastomosis had longer stent times of 22.2 days (28-17) while the patients with a running anastomosis has average stent times of 17.6 days (22-13). Average follow up is currently 4.9 months (2-10). Each patient is doing well with no signs of recurrent obstruction. Follow up has been documented with MAG3 renal scan with Lasix at 3, 6 and 9 months. Conclusion: The adoption of robotic technology into today's modern operating rooms has stimulated a new era in urologic surgery. The daVinci robot provides magnified three-dimensional vision and a miniature robotic articulating wrist that allows precise dissection and laparoscopic suturing. Robotic dismembered pyeloplasty is an excellent technique with very good results. As experience with the robotic instrumentation increases operative times fall quickly. Blood loss and pain are minimal, allowing early discharge home and quick recovery. The short-term results are promising. Longer follow-up is needed.