Geoff Coughlin - Academia.edu (original) (raw)
Papers by Geoff Coughlin
Archivos Espanoles De Urologia, May 1, 2007
To present a contemporary review of the functional outcomes following robotic-assisted radical pr... more To present a contemporary review of the functional outcomes following robotic-assisted radical prostatectomy based on published postoperative erectile function and urinary continence data. A review of the available literature on Medline and PubMed databases was performed. Factors affecting erectile function include age, preoperative SHIM scores, co-morbidities and nerve sparing techniques. Large robotic-assisted laparoscopic radical prostatectomy (RALP) series like the Vattikuti Institute's and Ohio State University's demonstrate early potency outcomes: 70% and 80% of patients, respectively, who underwent bilateral nerve sparing and had a pre-operative SHIM score > 17, regained potency after a follow-up of 12 months. This has also been reproduced by smaller series, where 43% of patients achieved potency within 3 months postop and 68%, 79% of patients who underwent unilateral or bilateral nerve sparing, respectively, were able to have intercourse with or without PDE5 inhibitors after 12 months follow-up. Postoperative continence rates after RALP for larger series are 76%-92% and 95. 2%-98% while that for smaller series range from 76% and 89% at 3 and 12 months, respectively. RALP is a safe, minimally invasive procedure that produces functional outcomes comparable to contemporary results of both open and laparoscopic prostatectomy.
PLOS ONE, 2015
To investigate the relationship between displacement of pelvic floor landmarks observed with tran... more To investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements. Three healthy men participated in this study, which included ultrasound imaging of the mid-urethra, urethra-vesical junction, ano-rectal junction and bulb of the penis. Fine-wire electromyography electrodes were inserted into the puborectalis and bulbocavernosus muscles and a transurethral catheter electrode recorded striated urethral sphincter electromyography. A nasogastric sensor recorded intra-abdominal pressure. Tasks included submaximal and maximal voluntary contractions, and Valsalva. The relationship between each of the parameters measured from ultrasound images and electromyography or intra-abdominal pressure amplitudes was described with nonlinear regression. Strong, non-linear relationships were calculated for each predicted landmark/muscle pair for submaximal contractions (R2-0.87-0.95). The relationships between mid-urethral displacement and striated urethral sphincter electromyography, and bulb of the penis displacement and bulbocavernosus electromyography were strong during maximal contractions (R2-0.74-0.88). Increased intra-abdominal pressure prevented shortening of puborectalis, which resulted in weak relationships between electromyography and anorectal and urethravesical junction displacement during all tasks. Displacement of landmarks in transperineal ultrasound imaging provides meaningful measures of activation of individual pelvic floor muscles in men during voluntary contractions. This method may aid assessment of muscle function or feedback for training.
Neurourology and Urodynamics, 2015
To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as qu... more To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as quantified by transperineal ultrasound imaging (US) and to validate these measures with invasive EMG recordings. Methods: Displacement of pelvic floor landmarks on transperineal US, intra-abdominal pressure (IAP) recorded with a nasogastric transducer, and surface EMG of the abdominal muscles and anal sphincter were recorded in 15 healthy men during submaximal PFM contractions in response to different verbal instructions: ''tighten around the anus,'' ''elevate the bladder,'' ''shorten the penis,'' and ''stop the flow of urine.'' In three men, fine-wire EMG recordings were made from puborectalis and bulbocavernosus, and trans-urethral EMG recordings from the striated urethral sphincter (SUS). Displacement data were validated by analysis of relationship with invasive EMG. Displacement, IAP, and abdominal/anal EMG were compared between instructions. Results: Displacement of pelvic landmarks correlated with the EMG of the muscles predicted anatomically to affect their locations. Greatest dorsal displacement of the mid-urethra and SUS activity was achieved with the instruction ''shorten the penis.'' Instruction to ''elevate the bladder'' induced the greatest increase in abdominal EMG and IAP. ''Tighten around the anus'' induced greatest anal sphincter activity. Conclusions: The pattern of urethral movement measured from transperineal US is influenced by the instructions used to teach activation of the pelvic floor muscles in men. Efficacy of PFM training may depend on the instructions used to train activation. Instructions that optimize activation of muscles with a potential to increase urethral pressure without increasing abdominal EMG/IAP are likely ideal. Neurourol. Urodynam. # 2015 Wiley Periodicals, Inc.
European Urology Supplements, 2008
Archivos españoles de urología, 2007
To present a contemporary review of the functional outcomes following robotic-assisted radical pr... more To present a contemporary review of the functional outcomes following robotic-assisted radical prostatectomy based on published postoperative erectile function and urinary continence data. A review of the available literature on Medline and PubMed databases was performed. Factors affecting erectile function include age, preoperative SHIM scores, co-morbidities and nerve sparing techniques. Large robotic-assisted laparoscopic radical prostatectomy (RALP) series like the Vattikuti Institute's and Ohio State University's demonstrate early potency outcomes: 70% and 80% of patients, respectively, who underwent bilateral nerve sparing and had a pre-operative SHIM score > 17, regained potency after a follow-up of 12 months. This has also been reproduced by smaller series, where 43% of patients achieved potency within 3 months postop and 68%, 79% of patients who underwent unilateral or bilateral nerve sparing, respectively, were able to have intercourse with or without PDE5 inhib...
Urologic Robotic Surgery in Clinical Practice, 2008
In the USA, approximately 77,000 radical prostatectomies are performed yearly for the treatment o... more In the USA, approximately 77,000 radical prostatectomies are performed yearly for the treatment of prostate cancer. Although a number of alternative treatment options are available for organ-confined prostate cancer, retropubic radical prostatectomy (RRP) remains the gold standard demonstrating a reduction in disease-specific mortality for affected patients.
Journal of Endourology - J ENDOUROL, 2008
The Journal of Urology, 2005
1. J Urol. 2005 Sep;174(3):912-4; discussion 914. Robotic assisted laparoscopic radical prostatec... more 1. J Urol. 2005 Sep;174(3):912-4; discussion 914. Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. Webster TM, Herrell SD, Chang ...
The Journal of Urology, 2010
The Journal of Urology, 2008
Journal of Robotic Surgery, 2009
Several studies have attempted to define the learning curve associated with robot-assisted laparo... more Several studies have attempted to define the learning curve associated with robot-assisted laparoscopic prostatectomy (RALP). These studies have focused on the acquisition of skills by novice robotic surgeons. It is unclear, however, if basic proficiency can be equated with satisfactory patient outcomes. We surveyed experienced robotic surgeons with high surgical volume in an attempt to define an “advanced” learning curve,
Journal of Endourology, 2008
Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity as a treatment option... more Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity as a treatment option for prostate cancer. As a new technology, little is known regarding the reliability of the da Vinci robotic system. Intraoperative robotic equipment malfunction may force the surgeon to convert the procedure to an open or pure laparoscopic procedure, or possibly even abort the procedure. We report the first large-scale, multi-institutional review of robotic equipment malfunction. A questionnaire was designed to evaluate the rate of perioperative robotic malfunction during RALP. High-volume, experienced surgeons were asked to complete this evaluation based on the analysis of their data. Questions included the overall number of RALPs performed, the number of equipment malfunctions, the number of procedures that had to be converted or aborted, and the part of the robotic system that malfunctioned. Eleven institutions participated in the study with a median surgeon volume of 700 cases, accounting for a total case volume of 8240. Critical failure occurred in 34 cases (0.4%) leading to the cancellation of 24 cases prior to the procedure, and the conversion to two laparoscopic and eight open procedures. The most common components of the robot to malfunction were the arms and optical system. Critical robotic equipment malfunction is extremely rare in institutions that perform high volumes of RALPs, with a nonrecoverable malfunction rate of only 0.4%.
Journal of Endourology, 2008
Journal of Endourology, 2008
... J Endourol 2004;18:269272. Address reprint requests to: Vipul R. Patel, MD Global Robotics I... more ... J Endourol 2004;18:269272. Address reprint requests to: Vipul R. Patel, MD Global Robotics Institute 410 Celebration Place, Suite 200 Celebration, Florida 34747 E-mail: vipul.patel.md@ flhosp.org ROBOT-ASSISTED RADICAL CYSTECTOMY 2077 Page 6.
Journal of Endourology, 2008
Journal of Endourology, 2009
Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential ... more Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential to revolutionize our approach to abdominal surgery. Performing operations via a flexible endoscope introduced through a natural orifice presents several challenges to physicians. Orientation and interpretation of the endoscopic video image can be difficult. The surgeon must also learn to operate with the camera and instruments "in line." Advances in technology are currently addressing the challenges of NOTES. Image-guided navigation could potentially provide invaluable assistance during NOTES. Real-time information on spatial positioning and orientation as well as assistance with the identification of anatomy and localization of pathology are some of the possibilities. Image-guided surgery has become commonplace in disciplines such as neurosurgery where the anatomy is relatively rigid. To become widespread in intra-abdominal procedures and NOTES, advances that will allow systems to adapt to moving and deforming anatomy are needed. This article reviews the basics of image-guided surgery, the various image-guided systems, and their potential application to NOTES.
Journal of Endourology, 2012
To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive su... more To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP). We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of "no pads" postoperatively. A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75 min, P<0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P=0.870), 4 weeks (42.3% vs 48%, P=0.136), 12 weeks (82.5% vs 86.8%, P=0.107), and 24 weeks (91.5% vs 94.1%, P=0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5 wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5 wks, CI 4.66-5.34; log rank test, P=0.113). The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon.
International Journal of Urology, 2010
We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to... more We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to date. In the present study, we detail our current technique at Yonsei University College of Medicine. The six-port transperitoneal approach is utilized. The most lateral two ports ...
The International Journal of Medical Robotics and Computer Assisted Surgery, 2007
Over the last decade minimally invasive endourologic and laparoscopic techniques have become the ... more Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system.
Archivos Espanoles De Urologia, May 1, 2007
To present a contemporary review of the functional outcomes following robotic-assisted radical pr... more To present a contemporary review of the functional outcomes following robotic-assisted radical prostatectomy based on published postoperative erectile function and urinary continence data. A review of the available literature on Medline and PubMed databases was performed. Factors affecting erectile function include age, preoperative SHIM scores, co-morbidities and nerve sparing techniques. Large robotic-assisted laparoscopic radical prostatectomy (RALP) series like the Vattikuti Institute's and Ohio State University's demonstrate early potency outcomes: 70% and 80% of patients, respectively, who underwent bilateral nerve sparing and had a pre-operative SHIM score > 17, regained potency after a follow-up of 12 months. This has also been reproduced by smaller series, where 43% of patients achieved potency within 3 months postop and 68%, 79% of patients who underwent unilateral or bilateral nerve sparing, respectively, were able to have intercourse with or without PDE5 inhibitors after 12 months follow-up. Postoperative continence rates after RALP for larger series are 76%-92% and 95. 2%-98% while that for smaller series range from 76% and 89% at 3 and 12 months, respectively. RALP is a safe, minimally invasive procedure that produces functional outcomes comparable to contemporary results of both open and laparoscopic prostatectomy.
PLOS ONE, 2015
To investigate the relationship between displacement of pelvic floor landmarks observed with tran... more To investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements. Three healthy men participated in this study, which included ultrasound imaging of the mid-urethra, urethra-vesical junction, ano-rectal junction and bulb of the penis. Fine-wire electromyography electrodes were inserted into the puborectalis and bulbocavernosus muscles and a transurethral catheter electrode recorded striated urethral sphincter electromyography. A nasogastric sensor recorded intra-abdominal pressure. Tasks included submaximal and maximal voluntary contractions, and Valsalva. The relationship between each of the parameters measured from ultrasound images and electromyography or intra-abdominal pressure amplitudes was described with nonlinear regression. Strong, non-linear relationships were calculated for each predicted landmark/muscle pair for submaximal contractions (R2-0.87-0.95). The relationships between mid-urethral displacement and striated urethral sphincter electromyography, and bulb of the penis displacement and bulbocavernosus electromyography were strong during maximal contractions (R2-0.74-0.88). Increased intra-abdominal pressure prevented shortening of puborectalis, which resulted in weak relationships between electromyography and anorectal and urethravesical junction displacement during all tasks. Displacement of landmarks in transperineal ultrasound imaging provides meaningful measures of activation of individual pelvic floor muscles in men during voluntary contractions. This method may aid assessment of muscle function or feedback for training.
Neurourology and Urodynamics, 2015
To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as qu... more To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as quantified by transperineal ultrasound imaging (US) and to validate these measures with invasive EMG recordings. Methods: Displacement of pelvic floor landmarks on transperineal US, intra-abdominal pressure (IAP) recorded with a nasogastric transducer, and surface EMG of the abdominal muscles and anal sphincter were recorded in 15 healthy men during submaximal PFM contractions in response to different verbal instructions: ''tighten around the anus,'' ''elevate the bladder,'' ''shorten the penis,'' and ''stop the flow of urine.'' In three men, fine-wire EMG recordings were made from puborectalis and bulbocavernosus, and trans-urethral EMG recordings from the striated urethral sphincter (SUS). Displacement data were validated by analysis of relationship with invasive EMG. Displacement, IAP, and abdominal/anal EMG were compared between instructions. Results: Displacement of pelvic landmarks correlated with the EMG of the muscles predicted anatomically to affect their locations. Greatest dorsal displacement of the mid-urethra and SUS activity was achieved with the instruction ''shorten the penis.'' Instruction to ''elevate the bladder'' induced the greatest increase in abdominal EMG and IAP. ''Tighten around the anus'' induced greatest anal sphincter activity. Conclusions: The pattern of urethral movement measured from transperineal US is influenced by the instructions used to teach activation of the pelvic floor muscles in men. Efficacy of PFM training may depend on the instructions used to train activation. Instructions that optimize activation of muscles with a potential to increase urethral pressure without increasing abdominal EMG/IAP are likely ideal. Neurourol. Urodynam. # 2015 Wiley Periodicals, Inc.
European Urology Supplements, 2008
Archivos españoles de urología, 2007
To present a contemporary review of the functional outcomes following robotic-assisted radical pr... more To present a contemporary review of the functional outcomes following robotic-assisted radical prostatectomy based on published postoperative erectile function and urinary continence data. A review of the available literature on Medline and PubMed databases was performed. Factors affecting erectile function include age, preoperative SHIM scores, co-morbidities and nerve sparing techniques. Large robotic-assisted laparoscopic radical prostatectomy (RALP) series like the Vattikuti Institute's and Ohio State University's demonstrate early potency outcomes: 70% and 80% of patients, respectively, who underwent bilateral nerve sparing and had a pre-operative SHIM score > 17, regained potency after a follow-up of 12 months. This has also been reproduced by smaller series, where 43% of patients achieved potency within 3 months postop and 68%, 79% of patients who underwent unilateral or bilateral nerve sparing, respectively, were able to have intercourse with or without PDE5 inhib...
Urologic Robotic Surgery in Clinical Practice, 2008
In the USA, approximately 77,000 radical prostatectomies are performed yearly for the treatment o... more In the USA, approximately 77,000 radical prostatectomies are performed yearly for the treatment of prostate cancer. Although a number of alternative treatment options are available for organ-confined prostate cancer, retropubic radical prostatectomy (RRP) remains the gold standard demonstrating a reduction in disease-specific mortality for affected patients.
Journal of Endourology - J ENDOUROL, 2008
The Journal of Urology, 2005
1. J Urol. 2005 Sep;174(3):912-4; discussion 914. Robotic assisted laparoscopic radical prostatec... more 1. J Urol. 2005 Sep;174(3):912-4; discussion 914. Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. Webster TM, Herrell SD, Chang ...
The Journal of Urology, 2010
The Journal of Urology, 2008
Journal of Robotic Surgery, 2009
Several studies have attempted to define the learning curve associated with robot-assisted laparo... more Several studies have attempted to define the learning curve associated with robot-assisted laparoscopic prostatectomy (RALP). These studies have focused on the acquisition of skills by novice robotic surgeons. It is unclear, however, if basic proficiency can be equated with satisfactory patient outcomes. We surveyed experienced robotic surgeons with high surgical volume in an attempt to define an “advanced” learning curve,
Journal of Endourology, 2008
Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity as a treatment option... more Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity as a treatment option for prostate cancer. As a new technology, little is known regarding the reliability of the da Vinci robotic system. Intraoperative robotic equipment malfunction may force the surgeon to convert the procedure to an open or pure laparoscopic procedure, or possibly even abort the procedure. We report the first large-scale, multi-institutional review of robotic equipment malfunction. A questionnaire was designed to evaluate the rate of perioperative robotic malfunction during RALP. High-volume, experienced surgeons were asked to complete this evaluation based on the analysis of their data. Questions included the overall number of RALPs performed, the number of equipment malfunctions, the number of procedures that had to be converted or aborted, and the part of the robotic system that malfunctioned. Eleven institutions participated in the study with a median surgeon volume of 700 cases, accounting for a total case volume of 8240. Critical failure occurred in 34 cases (0.4%) leading to the cancellation of 24 cases prior to the procedure, and the conversion to two laparoscopic and eight open procedures. The most common components of the robot to malfunction were the arms and optical system. Critical robotic equipment malfunction is extremely rare in institutions that perform high volumes of RALPs, with a nonrecoverable malfunction rate of only 0.4%.
Journal of Endourology, 2008
Journal of Endourology, 2008
... J Endourol 2004;18:269272. Address reprint requests to: Vipul R. Patel, MD Global Robotics I... more ... J Endourol 2004;18:269272. Address reprint requests to: Vipul R. Patel, MD Global Robotics Institute 410 Celebration Place, Suite 200 Celebration, Florida 34747 E-mail: vipul.patel.md@ flhosp.org ROBOT-ASSISTED RADICAL CYSTECTOMY 2077 Page 6.
Journal of Endourology, 2008
Journal of Endourology, 2009
Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential ... more Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential to revolutionize our approach to abdominal surgery. Performing operations via a flexible endoscope introduced through a natural orifice presents several challenges to physicians. Orientation and interpretation of the endoscopic video image can be difficult. The surgeon must also learn to operate with the camera and instruments "in line." Advances in technology are currently addressing the challenges of NOTES. Image-guided navigation could potentially provide invaluable assistance during NOTES. Real-time information on spatial positioning and orientation as well as assistance with the identification of anatomy and localization of pathology are some of the possibilities. Image-guided surgery has become commonplace in disciplines such as neurosurgery where the anatomy is relatively rigid. To become widespread in intra-abdominal procedures and NOTES, advances that will allow systems to adapt to moving and deforming anatomy are needed. This article reviews the basics of image-guided surgery, the various image-guided systems, and their potential application to NOTES.
Journal of Endourology, 2012
To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive su... more To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP). We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of "no pads" postoperatively. A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75 min, P<0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P=0.870), 4 weeks (42.3% vs 48%, P=0.136), 12 weeks (82.5% vs 86.8%, P=0.107), and 24 weeks (91.5% vs 94.1%, P=0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5 wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5 wks, CI 4.66-5.34; log rank test, P=0.113). The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon.
International Journal of Urology, 2010
We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to... more We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to date. In the present study, we detail our current technique at Yonsei University College of Medicine. The six-port transperitoneal approach is utilized. The most lateral two ports ...
The International Journal of Medical Robotics and Computer Assisted Surgery, 2007
Over the last decade minimally invasive endourologic and laparoscopic techniques have become the ... more Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system.