Robotic Approaches to Augmentation Cystoplasty: Ready for Prime Time? Ready for Prime Time?

Robotic technology provides the advantages of minimally invasive surgery with the ability to replicate open approaches, leading to similar functional outcomes in both adult and pediatric urology. Therefore, it is being increasingly used for complex reconstructive procedures such as augmentation cystoplasty. Though this is only being performed at select centers, institutional reports have documented outcomes comparable to the open approach in properly selected patients. The technical demand of robotic augmentation cystoplasty necessitates a learning curve, making it longer and more expensive than the open approach. However, potential advantages include faster convalescence and decreased postoperative narcotic use and adhesion formation. Operative steps differ between surgeons, and variations in port placement have permitted some to perform concomitant procedures such as appendicovesicostomy, antegrade colonic enema (ACE), bladder neck closure, and double Yang-Monti conduit formation. Clarification of the role of robotic augmentation cystoplasty will come from continued evaluation with larger series and long-term follow-up.