Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair

Abstract

To review our experience of robotic redo pyeloplasty as a salvage procedure in previously failed repair of ureteropelvic junction (UPJ) obstruction. In one year, robot-assisted laparoscopic pyeloplasty was performed in nine patients for previously failed open pyeloplasty. Four of these patients had undergone additional retrograde endopyelotomy following failed repair, prior to being referred to us. The mean age was 16.4 years. All patients presented with persistent flank pain and an obstructive pattern on diuretic renogram. Robotic redo pyeloplasty could be performed successfully in all patients without any technical problems. Intraoperative findings for cause of UPJ obstruction were peri-ureteral fibrosis, narrow ureter, anterior crossing vessels, and redundant pelvis. The mean hospital stay was 3.4 days (2-5 days). All patients had improvement in symptoms and the nuclear scan showed non-obstructive drainage. Robot assisted redo pyeloplasty enables complex repair in patients with previous failed cases of UPJ obstruction repair. Three-dimensional magnified vision, and a dynamic articulated endowrist, allows fine dissection in the fibrosed area and precise suturing in an ergonomic fashion with a success equivalent to open surgery.

Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update

“…In addition, robot-assisted laparoscopic "reoperative" pyeloplasty in children with persistent UPJO after open surgical correction is also reported to be a safe and effective option in the treatment of these challenging indications (22,23).…”

Robotic Laparoscopic Pyeloplasty

“…Our operative time was 153.5 Ϯ 31 minutes in group 2, including intraoperative stent placement; this was slightly shorter than the operative time described by Atug et al 19 (mean, 279.8 minutes; range, 230 -414 minutes) but longer than that presented by Hemal et al 21 (106 minutes). Although direct comparisons with randomized double-blind studies are still not available, robotic assistance appears to reduce the operative time for this procedure.…”

“…One of those reports was published by Hemal et al, 21 applying robot-assisted laparoscopic pyeloplasty in 9 patients with previously failed open pyeloplasties. Comparably with our series, all patients in their report presented with favorable outcomes.…”

“…19,21 In our study, 1 patient, with a history of hemorrhagic rectocolitis, presented with peritonitis 7 days after the procedure, needing a secondary surgical procedure. Though a rare event, this complication has been described before when a pure laparoscopic approach was performed.…”

Robotic-assisted laparoscopic surgery in pediatric urology: an update

“…[21] Additionally, robot-assisted laparoscopic "reoperative" pyeloplasty in children with persistent UPJO after open surgical correction is also reported to be a safe and effective option in the treatment of these challenging cases. [22,23] Gargollo has reported an innovative "hidden incision endoscopic surgery" (HIdES) for performing pyeloplasty with elimination of visible scars. [24] All ports are placed at the umbilicus or below the line of a Pfannenstiel incision.…”