Robot Assisted Pyeloplasty : The da Vinci robotic surgical system has helped to overcome many of the challenges imposed by laparoscopy. Robotic surgery is similar to traditional laparoscopic surgery in that instruments are introduced into the body through several small incisions and manipulated under video guidance. Unlike conventional laparoscopy, in which the surgeon’s hands are directly linked to the instruments, in robotic surgery, the surgeon’s movements are made in a console that is remote from the patient and translated by the robotic arms. This procedure provides more freedom of movement to the wrist and less tremor which makes the suturing easy.

Retrograde Endopyelotomy : The procedure is same as above except that instead of a nephroscope, a ureteroscope is used which is inserted through the bladder and guided up to the renal pelvis. The narrowed part is removed and the stent is place from the bladder to the pelvis. This procedure can be performed in an outpatient setting.

Laparoscopic Pyeloplasty : The procedure was first carried out in 1993 and since then has steadily gained popularity among patients and surgeons alike. The steps of the procedure are same as in open pyeloplasty except that small cuts and microscopic instruments replace the large incisions. Though the procedure requires advanced skills, the shorter hospital stay and faster recovery make it a more popular option.

Percutaneous Antegrade Endopyelotomy : In this an incision is made directly over the region of upper pole of kidney. The nephroscope is inserted through the incision upto the renal pelvis and narrowed area. Micro instruments are then guided through the scope with the help of a camera and the narrowed portion is cut. The ureter and the pelvis are stitched up and a stent is positioned from the pelvis up to the bladder. The stent is kept in place for about 4-6 weeks. Faster recovery due to a small incision and lesser blood loss is the main advantage of the procedure.

Acucise Endopyelotomy : This procedure is similar to retrograde pyeloplasty except that a cutting wire and a balloon catheter is used. The balloon catheter has the cutting wire attached to it in the front. The balloon is filled with a contrast medium. The acucise catheter is guided through the bladder up to the pelvis. The balloon is inflated and position checked using fluoroscope. Then the cutting wire cuts the narrowed area. A ureteric stent is placed and the catheter is withdrawn.

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