Robot-Assisted Retroperitoneoscopic Traction-Aligned Suture Repair of Failed Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction

A case of redo pyeloplasty using robot-assisted retroperitoneoscopic pyeloplasty (RARP) for failed primary laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) is reported. A 12-year-old boy had LP elsewhere. He was referred for management of persistent left hydronephrosis, but was managed conservatively due to minimal symptoms and stable radioisotopic renography. When 26, he had a sudden onset of severe left flank caused by ureteropelvic anastomosis (UPA) stenosis. A double J stent was inserted and RARP was planned. A large retroperitoneal space was created using conventional retroperitoneoscopy and the proximal end of the stenosed UPA was excised. After docking a robotic surgical system, the most distal part of the renal pelvis was incised. Redo UPA was performed with interrupted sutures while approximating the edges by applying traction. There were no intraoperative complications. He remains asymptomatic 3 years postoperatively. Traction-aligned suturing during RARP facilitated redo pyeloplasty by enhancing the precision of suturing.