# Prone retroperitoneal robotic-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction

## TL;DR

A new robotic surgical approach for kidney obstruction shows promising results with short recovery and minimal complications.

## Contribution

A novel prone retroperitoneal robotic-assisted laparoscopic pyeloplasty technique is introduced and evaluated.

## Key findings

- All four procedures were completed robotically without conversion or reoperation.
- Mean operation time was 64.6 minutes with minimal blood loss and a short hospital stay.
- Postoperative renal function improved and obstruction-free recovery was achieved in all patients.

## Abstract

To evaluate the feasibility and preliminary outcomes of prone retroperitoneal robotic-assisted laparoscopic pyeloplasty (prRALP) for ureteropelvic junction obstruction (UPJO), an innovative approach designed to optimize surgical exposure and suturing.

This retrospective cohort study analyzed four patients who underwent prRALP between September 2023 and May 2024. The surgical technique involved prone positioning and multi-port robotic access, enabling direct posterior exposure of the renal pelvis and proximal ureter. Primary outcomes included operation time (OT), estimated blood loss (EBL), complications (Clavien-Dindo classification), and postoperative renal function (eGFR). Success was defined by radiographic resolution of obstruction, symptom relief, and no need for reintervention.

All procedures were completed robotically without open conversion and reoperation. Mean OT was 64.6 ± 14.4 min, with minimal blood loss of 27.5 ± 15.0 mL and no transfusions. The mean postoperative hospital stay was 3.3 ± 0.5 days. One minor complication (fever, Clavien 1) occurred (25%). Postoperative eGFR improved by 1.3 ± 14.2 mL/min/1.73 m2 at 90-day follow-up, with all patients achieving obstruction-free recovery and a mean eGFR of 87.2 ± 69.8 mL/min/1.73 m2 being maintained at 1-year postoperatively.

prRALP demonstrates feasibility and safety, leveraging prone position to enhance retroperitoneal access and suturing precision. Larger prospective studies are warranted to validate its technical benefits and reproducibility.