Robot-Assisted Pyelolithotomy in Pelvic Kidney

<b>Background/Objectives:</b> Pelvic kidney is a congenital anomaly characterized by the kidney's failure to ascend to its normal anatomical location during early embryonic development. This anomaly complicates traditional surgical approaches for renal calculi due to the kidney's atypical positioning and associated anatomical challenges. We sought to summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. <b>Methods:</b> A retrospective review of patients who underwent RPPK was conducted between 2014 and 2023. Demographic data on stone characteristics, operative details, and postoperative outcomes were analyzed. <b>Results:</b> Four patients (three male; mean age-51.2 years with a range of 45-54; mean BMI-26.6 with a range of 22.3-32.2) underwent RPPK. All had a right-sided pelvic kidney; two had prior failed ureteroscopy. The mean stone diameter was 27.7 mm (range: 17-35); the mean density was 1207.5 HU (range: 905-1500). The mean operative time was 265 min (range: 200-323); the time from incision to closure was 142.2 min (range: 95-225). No ureteral stents or drains were used. Blood loss was negligible. The mean hospital stay was 2.2 days. No immediate complications were recorded. The mean follow-up was 11.75 months (range: 3-30). <b>Conclusions:</b> RPPK is safe and effective for managing pelvic kidney stones. Challenging renal anatomy stone size and density are not obstacles to the robotic approach unlike other fragmentation methods.