First Robot-Assisted Laparoscopic Pyeloplasty Utilizing the da Vinci SP System

Introduction: Robotic pyeloplasty is an established treatment for ureteropelvic junction obstruction (UPJO) since the first series of robotic pyeloplasty was published in 2002.1 The robotic approach is now the popular approach for pyeloplasty in the United States.2 The newest robotic system da Vinci SP® (Intuitive Surgical, Sunnyvale, CA) is the latest evolution of robotic surgery, with limited information on feasibility for urologic cases. We demonstrate the first robot-assisted pyeloplasty utilizing this system. Materials and Methods: The patient is a 64 year-old woman with a history of right UPJO with progressive pain and declining right renal function. A robot-assisted laparoscopic pyeloplasty was performed utilizing the da Vinci SP system. Right retrograde pyelogram and stent placement were performed before robotic procedure, and patient was positioned in left lateral decubitus for the robotic portion of the procedure. Results: The procedure was performed without complication. A 2.5 cm periumbilical incision was carried through the abdominal fascia for insertion of the GelPOINT Mini® (Applied Medical, Rancho Santa Margarita, CA) system. The SP trocar was inserted through the GelPOINT Mini. The procedure was carried out in standard manner with no modification from a standard robotic pyeloplasty, with the exception of no dedicated assistant port. Total time on the robotic console was 105 minutes. Of note, only the da Vinci SP port was utilized, and no other assistant port was utilized for suction, clips, or suture passing. The patient was ready for dismissal on postoperative day (POD) 1, however stayed through POD 3 because of social reasons. Postoperatively, besides acetaminophen, patient only required 5 mg of oxycodone. She underwent stent removal 6 weeks postoperatively. At 3 months, patient had resolution of pain and no radiographic evidence of obstruction. Conclusion: The da Vinci SP robotic platform is suitable for robot-assisted pyeloplasty. No significant modifications are required to the standard technique. With this approach, one small incision hidden in the umbilicus can be utilized instead of multiple incisions with laparoscopic or multiport approaches. Further data are needed to assess noninferiority of the da Vinci SP system in this procedure and other urologic procedures. No competing financial interests exist. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 5 mins 51 secs