A combined approach of robot-assisted laparoscopic pyeloplasty and flexible endoscopy to treat concomitant ureteropelvic junction obstruction and calyceal stones in children: Technical considerations and review of the literature

Abstract

The management of children with concomitant ureteropelvic junction (UPJ) obstruction and calyceal stones remains challenging. The various treatment options available for pediatric nephrolithiasis may require multiple sessions, and the techniques by themselves are not designed for simultaneous correction of UPJ obstruction. Recently, success in combining robot-assisted laparoscopic pyeloplasty (RALP) and flexible endoscopy has been reported by multi-institutional studies to treat children with concomitant UPJ obstruction and renal stones. Given the paucity of technical details of this novel approach in the existing literature, we herein report our techniques to treat two girls aged 6 and 10 years who had concomitant UPJ obstruction and multiple stones in mid- and lower poles calyces. Three robotic ports were used without any assistant ports. A flexible endoscope, either a cystoscope or a single-use ureteroscope, was introduced via the undocked epigastric port to perform nephroscopy and stones removal after the renal pelvis was opened. The rest of the RALP was completed in the usual manner. Technical modifications were employed to facilitate the flexible endoscope to examine the entire calyceal system. Both patients underwent successful surgical procedures by the combined approach without any intra- or post-operative complications. Three and 14 stones were removed from each of the patients respectively. Postoperative investigations demonstrated successful correction of UPJ obstruction and complete stone clearance in both patients. A combined approach of RALP and flexible endoscopy is a safe and effective technique to treat concurrent UPJ obstruction and calyceal stones in children.

Pyeloplasty in Children with Ureteropelvic Junction Obstruction and Associated Kidney Anomalies: Can a Robotic Approach Make Surgery Easier?

“…Combining a flexible ureteroscope with robot-assisted approach can correct UPJO and remove renal calculi at the same time. This kind of approach can avoid the need for more interventions and it can reduce the number of anesthesiological procedures with the potential advantage of lowering the morbidity associated with multiple access routes to the kidneys [ 31 , 32 , 33 , 34 ]. Our experience, although limited, was able to show similar results, which proved encouraging both because the operative time was not significantly longer than that of standard pyeloplasty and because the operative act, thanks to robotic technology, did not prove difficult to perform.…”

A Planar-Type Micro-Biopsy Tool for a Capsule-Type Endoscope Using a One-Step Nickel Electroplating Process

“…Soft tissue inspection and sampling has been conducted using both an endoscope and an integrated dissection tool, which are used for abnormal tissue monitoring and biopsy, respectively [1][2][3][4]. In the case of gastrointestinal endoscopic monitoring, conventional flexible endoscopes have been used, but they frequently cause discomfort to patients during inspection and operation [5,6].…”