Objectives. Robotic technology has been employed to manipulate the laparoscope during urologic procedures. However, to our knowledge, robotic technology has not been previously applied to actually perform the urologic laparoscopic procedure. The objective of this study was to determine the feasibility and efficacy of performing robotic-assisted laparoscopic pyeloplasty and compare it with conventional laparoscopic pyeloplasty in an acute porcine model.

Methods. Five female swine (10 kidneys) were prospectively randomized to undergo unstented robotic-assisted laparoscopic pyeloplasty (6 kidneys) or conventional laparoscopic pyeloplasty (4 kidneys). Robotic pyeloplasty was performed with the Zeus robotic system, which incorporates three remote-controlled interactive arms: one voice-activated arm to control the laparoscope and two robotic arms to manipulate purpose-designed instruments. Tissue dissection and transection of ureteropelvic junction area were performed manually by conventional laparoscopy. The pyeloureteric anastomosis during the robotic-assisted pyeloplasty was performed completely robotically from a remote workstation using running 5-0 absorbable sutures. Conventional laparoscopic pyeloplasty was performed manually by laparoscopic intracorporeal suturing and knot-tying techniques. Immediate patency and anastomotic integrity were evaluated by intravenous indigo carmine and ex vivo retrograde ureteropyelogram.

Results. In comparing robotic and conventional laparoscopic pyeloplasty, the following data were obtained: total surgical time (115.2 versus 94.5 minutes, P = 0.2), anastomosis time (75.7 versus 64.3 minutes, P = 0.3), and total number of suture-bites per ureter (13.0 versus 12.5, P = 0.8). Anastomoses were immediately watertight in 5 of 6 robotic and 3 of 4 conventional pyeloplasties.

Conclusions. Robotic-assisted laparoscopic pyeloplasty is a feasible and effective procedure that may enhance surgical dexterity and precision. This has implications for clinical applications of laparoscopic telesurgery in the future.