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DOI: 10.1111/iju.14150 The application of RALP for UPJO was approved by the Kyoto Prefectural University of Medicine institutional review board (IRB 201840, UMIN 000020461). We report our initial experience of the RALP procedure, which follows our earlier introduction of the LP procedure in 2003 and LESS-P procedure in 2010. There have been several reports comparing RALP with LP, but no reports that compared the three different procedures, including RALP, LESS-P and LP, in which a single surgeon operated on adults. We compared each result of the initial experience of these three procedures, which were carried out by a single operator, in five consecutive adult patients with UPJO in order to verify the features of RALP, LESS-P and LP. Overall operative time, port-placement time, time for spatulating the proximal ureter, time for suturing the ureter to the renal pelvis including ureteral stenting time and the success rate were compared. Surgery was indicated for patients in which the split renal dysfunction was progressive or for patients with clinically significant symptoms. The definition of success was improvement of split renal function or disappearance of symptoms. All surgeries were carried out using the intraperitoneal approach of the Anderson–Hynes technique. Patient characteristics and surgical results are shown in Table 1. No significant difference of overall operative time was observed among the three procedures. The port placement time in RALP was significantly longer than that in LP (P = 0.002). The suturing time in RALP was relatively shorter than that in LP, but not significant (P = 0.13). The time for suturing in LESS-P was significantly longer than that in RALP (P = 0.007), and tended to be longer than that in LP (P = 0.06). The time for spatulating the ureter in RALP was significantly shorter than that in LESS-P (P = 0.003) and LP (P = 0.004). No complications were observed in any of the procedures. The success rate was 100% based on the definition of success. The present findings showed that the time taken for port placement in RALP was longer than that in LP. It was pointed out that docking of the robot is thought to take a certain time, especially in facilities with limited experience. It is widely known that the da Vinci System allows surgeons to easily suture, as it is equipped with articulating mechanisms and forceps with a high degree of freedom. In contrast, suturing is known to be challenging in LESS-P, as it has limited working space. Although RALP might have a learning curve, it has also been reported that experience with LP contributes to a reduction of the learning curve for RALP. It is expected that the time can be shortened through experience of more robotic procedures. When LESS-P was compared with RALP, it was found that the time for suturing and spatulating the ureter was longer in LESS-P than in RALP. LESS-P was compared with LP, and the time for suturing tended to be longer for LESS-P. These results coincided with a report showing that suturing is challenging in LESS-P, and that LESS-P is difficult in early experience. The advantages of LESS-P included a superior cosmetic outcome than conventional LP or RALP, and a lower degree of postoperative pain. There have been no previous reports on the time taken for spatulating the ureter. This procedure can be carried out in a short time, and it might not be a factor that greatly affects the overall operative time. However, the high degree of freedom in operation, which is an advantage of robotic surgery, has been recognized as an advantage, and it is considered to be one of the important features that the da Vinci System brings to pyeloplasty. We evaluated three different procedures carried out by a single operator in five patients as initial experience for each procedure. We analyzed the time required for each procedure by dividing the procedures into multiple steps. Although LESS-P is comparable to other surgeries in terms of the results of surgery, it was shown that inexperienced surgeons have difficulty with suturing in LESS-P. As RALP is comparable to the other procedures in order to achieve the goal of the surgery, and has advantages with respect to suture techniques and spatulating the ureter, it was considered to reflect its advantage of articulating mechanisms and forceps