General hospital Celje, Urological Department, Slovenia
Ureteropelvic junction obstruction (UPJO) has traditionally been treated by open pyeloplasty. Anderson-Hynes dismembered pyeloplasty has reported success rates in excess of 90% and other treatments must be compared with it. The endourological approaches, anterograde and retrograde, are less invasive but with lower success rates. Laparoscopic pyeloplasty has success rates comparable to open approaches. The technical challenges with intracorporeal suturing limited the widespread use of laparoscopic pyeloplasty. The introduction of robotic surgery has helped to reduce some limitations of laparoscopic pyeloplasty.
Patients and methods
Between March 2011 and February 2012, 4 patients, 1 woman and 3 men, mean age 33 years, range 22-51, had transperitoneal robotic assisted pyeloplasty (RAP). The initial diagnosis was precipitated by renal colic in 3 patients and in 1 patient, incidentally. The diagnosis was confirmed by US, IVP and furosemide MAG3 renal scintigraphy to assess kidney function and obstruction. UPJO was on the right side in 1 and on the left side in 3 patients with no previous treatment. RAP was done in 60 flank position. Three robotic ports and 1 assistant port were used in all cases for dismembered pyeloplasty. UPJ was transected, ureter spatulated and rebundant pelvis excised using monopolar scissors and bipolar Maryland grasper. A needle driver was used to create anastomosis with running suture. A 7 F JJ stent was inserted anterogradely over a guidewire. Foley catheter was removed 2 days and drain 3 days after surgery. JJ stent was removed 4 weeks after surgery.
In all patients the RAP was completed using da Vinci S HD system with no conversion and complication during surgery. Estimated blood loss was 50 ml in all patients. The robot docking time was 15-20 min. The console time was 100min., 165 min., 135 min. and 150 min.. The postoperative hospital stay was 3 days, 4 days and 5 days for 2 patients. The follow up is 12 months, 4 m. and 2 m. for 2 patients. All patients were well at last visit.
Robotic assisted pyeloplasty is a feasible technique with the same results as open pyeloplasty. Compared with laparoscopic techniques, it has better suturing quality and shorter learning curve. All in all, we are satisfied with our initial results.