Prone retroperitoneal robotic-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction

Objective 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. Methods 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. Results 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 m 2 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 m 2 being maintained at 1-year postoperatively. Conclusion 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.