Background: Robotic-assisted laparoscopic surgery has advanced minimally invasive urology. However, the absence of haptic feedback may increase the risk of tissue trauma. This case series evaluates a no-touch technique in robotic-assisted pyeloplasty to minimize urothelial handling and assess its feasibility and short-term outcomes.

Methods: This retrospective case series reviewed 20 pediatric patients with ureteropelvic junction obstruction treated with robotic-assisted pyeloplasty between 2019 and 2022. In 10 cases, a no-touch urothelium approach was applied to minimize direct tissue handling. Patient selection, surgical details, perioperative outcomes, and follow-up at 6 and 12 months were documented.

Results: The no-touch approach was successfully implemented in all cases without intraoperative complications. Median console time was 98 min (IQR: 81-131). Postoperative outcomes were favorable, with significant improvement or resolution of hydronephrosis in all cases. No major complications occurred, and no anastomotic strictures were observed during follow-up.

Conclusions: The no-touch technique in robotic-assisted pyeloplasty is a feasible approach that maintains surgical efficiency while minimizing direct urothelial handling. Further studies with larger sample sizes and longer follow-up are needed to validate its potential benefits.

Trial registration: This study was approved by the Institutional Review Board of New Children's Hospital, Helsinki University Hospital (permit nr 5485), Finland.