Initial experience with primary and redo robotic pyeloplasty using the Versius robotic system (CMR)

Background: Robotic-assisted pyeloplasty is a well-established minimally invasive technique for the management of pelvi-ureteric junction obstruction (PUJO). The Versius Robotic System (CMR) is a state-of-the-art robotic technology that is increasingly being used in urologic surgery. The aim of this study was to evaluate the outcomes of primary and redo robotic pyeloplasty with the Versius robotic system in patients undergoing surgery at the Pakistan Kidney and Liver Institute & Research Center (PKLI & RC), Lahore. Methods: This is a retrospective study carried out on 74 patients who underwent robotic pyeloplasty between May 2023 and July 2025. Data on demographics, intraoperative parameters, and postoperative outcomes were analyzed. Results: Seventy-four patients underwent robotic pyeloplasty with the Versius robotic system. Of these, 65 (87.8%) were primary cases and 9 (12.2%) were redo procedures. The mean age of these patients was 32.5 ± 10.7 years. There were 44 (59.5%) males in our study. The mean operative time was 157.1 ± 35.8 min, and the console time was 80.3 ± 12.9 min. The median blood loss was 50 mL (IQR: 54). Conversion to open surgery occurred in four patients (5.4%). Early postoperative complications occurred in six patients (8.1%), while late complications were observed in eight patients (10.8%). Median hospital stay was 1 day (IQR: 0). Symptomatic improvement occurred in all patients (74, 100%), while radiological improvement was observed in 61 patients (82.4%) at a mean follow-up of 10.1 ± 1.5 weeks. Conclusion: Robotic pyeloplasty using the Versius system is a safe, feasible, and effective option for both primary and redo PUJO, providing favorable perioperative outcomes and rapid recovery.