Lately the robotic pyeloplasty is considered by many as the preferred technique in the treatment of the hydronephrosis due to the UPJ stricture. In our opinion there is a less invasive option to be chosen. We present our technique of minilaparoscopic pyeloplasty (MLP).

300 symptomatic patients with hydronephrosis due to the UPJ stricture were operated from January 2014 to December 2024.   The Hynes-Anderson procedure was performed in all cases with antegrade insertion of stent. MLP was performed with 2 or 3 3.5mm Storz trocars and one 5mm (for high definition laparoscope) or 10mm (for 3D optics) always inserted through umbilicus.   The anastomosis was performed by continuous 4 or 5-0 monofilament unbarbed sutures with KOH microneedleholders.  The drain was left for 1 – 2 days and urethral catheter for 3-4 days. Patient was discharged after no evidence of obstruction, urine collection or kidney pain. Stent was removed in 6 weeks and control renal scans were done in 3-6 months.

Only 10 patients were converted to standard laparoscopy due to prominent scar process found in recurrent cases. No intraoperative complications were noted. Mean operative time was 82 (54 – 140) minutes. The recurrence happened in 3 cases, that were successfully treated by repeat MLP. In 3-4 months 3mm ports incisions resemble small birthmarks.

Minilaparoscopic pyeloplasty is safe and feasible procedure. Technical precision achieved by microlaparoscopic instruments and high quality video systems leaded to excellent results, short operative time and thus had become a standard procedure in our clinic.