Surgical correction of an obstruction between the kidney and the tube (ureter) that takes urine to the bladder, also known as an ureteropelvic junction obstruction (UPJ), was described by Trendelenberg in 1886. Since that time, a number of advances in techniques to correct UPJ obstruction have been made, and one of these modern approaches is laparoscopic pyeloplasty. Laparoscopic pyeloplasty was first described in 1993, by Schuessler (et al.)
Over the past decade, laparoscopic pyeloplasty has gained acceptance by mirroring the principles and results of open surgery without the associated morbidity of a flank incision.
However, pure laparoscopic pyeloplasty requires the necessary skills to perform precise intracorporeal suturing. The introduction of computer-assisted robotic surgical systems has enhanced the ability to perform intracorporeal suturing with a short learning curve and high precision.
Reported small series comparing standard laparoscopic pyeloplasty to robotic pyeloplasty revealed shorter total operative time and UPJ anastomosis times in the latter with excellent success rates and minimal complications.
Robotic-assisted dismembered pyeloplasty can be performed efficiently by the retroperitoneal laparoscopic technique. Our surgical outcomes are comparable to previously published laparoscopic and transperitoneal robotic-assisted dismembered pyeloplasty series in adults with excellent clinical and radiologic success rates.
Ten adult patients with unilateral ureteropelvic junction (UPJ) obstruction underwent robotic-assisted retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty between February 2004 and March 2005. UPJ obstruction was primary in six patients and secondary in four patients after failed endopyelotomy. Dismembered pyeloplasty was performed utilizing a retroperitoneal approach (developed by balloon dissection). Three retroperitoneal laparoscopic ports were placed for the robot, and a fourth port was used by the assistant. Robotic-assisted laparoscopic technique was utilized to perform the entire procedure in all cases.
All cases (seven right, three left) were successfully completed using the robot without conversion to conventional laparoscopic or open technique.
||Median (CI 95%)
CI = confidence interval.
a Time from skin incision till incisions sutured, excluding stent placement time.
b Time from the patient enters the room until the time the patient leaves the room
c Reported as mean follow-up.
|Total operative time (min)a
||175 (95% CI 128–185)
|Total cystoscopy time (min)
||25 (95% CI 21–32)
|Total time patient spend in operating room (min)b
||295 (95% CI 279–340)
|Estimated blood loss (mL)
||50 (95% CI 26–62)
|Total length of hospital stay (h)
||48 (95% CI 27–65)
|Jackson-Pratt Drain removal (d)
|Resolution of flank pain postoperatively
||All 10 patients