Ultra Minimally Invasive Single Port Robot-Assisted Pyeloplasty

Our case series study evaluates the supine anterior retroperitoneal access (SARA) technique for single-port (SP) robot-assisted pyeloplasty in treating ureteropelvic junction (UPJ) obstruction.

PATIENTS, METHODS AND SURGICAL TECHNIQUE

The technique's feasibility and perioperative outcomes were assessed in a series of 9 patients treated between July 2024 and August 2025. The SARA approach utilizes a single 3-cm incision in a supine patient to directly access the retroperitoneal space, avoiding the peritoneal cavity. The procedure was performed with the robotic platform.

RESULTS

Results demonstrated the technique's safety and efficiency. The median operative time was 144 minutes with minimal blood loss (less than 30ml) and no major intraoperative complications. Patient recovery was swift, characterized by low postoperative pain, with 56% of patients discharged by the second day and 44% of patients discharged by the third day. While three patients had minor (Clavien- Dindo grade I) events, only one patient experienced a recurrence requiring reoperation. Renal function was preserved and slightly improved at discharge.

CONCLUSIONS

In conclusion, the SARA approach for SP robotic pyeloplasty is a practical and effective minimally invasive solution. It provides excellent surgical outcomes while facilitating rapid patient recovery with low pain and short hospital stays.