Minimally invasive pyeloplasty has achieved success that has approached open pyeloplasty. Key principles such as removal of fibrosis, extensive mobilization of the ureteropelvic junction and crossing vessels, and creation of a tension-free, widely spatulated anastamosis are important in successful repair. In this review, we discuss the preparation and operative steps in performing a robotic pyeloplasty. Patient selection and diagnostic approach is discussed in the preoperative setting. Important surgical steps described include port placement, management of crossing vessels, division and spatulation of the ureter, and reanastamosis. Finally, management of more difficult cases is discussed.
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