Skip to main content
SpringerLink
Log in

Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

This pilot study was designed to interpret the technically specific features of the avatera robotic system and present our initial experience with this novel platform in robot-assisted pyeloplasty (RAP).

Methods

A single-center prospective study was conducted including all patients who underwent RAP with the avatera robotic system from June 2022 to October 2022 in our Department. Transperitoneal robot-assisted dismembered pyeloplasty was performed in all cases. The trocar placement and the surgical technique were similar in all patients. The successful completion of the procedures, operation time (including draping, docking and console time), decrease in hemoglobin postoperatively, and presence of any complications were the study’s primary endpoints.

Results

In total, nine patients underwent RAP using the avatera system. All procedures were successfully completed. The draping of the robotic unit was completed in a median time of 10 min (range 7–15), while the median docking time was 17 min (range 10–24). The median console time was 88 min (range 78–116) and no complications were noticed. The median hemoglobin drop was calculated to 0.7 g/dL (range 0.4–1). During the mean follow-up of 9.33 ± 2.78 months, no late postoperative complications were noticed.

Conclusion

The early outcomes of the use of the novel avatera system in RAP are presented. All operations were successfully completed with safety and efficacy, without complications or significant blood loss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Vemulakonda VM (2021) Ureteropelvic junction obstruction: diagnosis and management. Curr Opin Pediatr 33(2):227–234

    Article  CAS  PubMed  Google Scholar 

  2. Metcalfe PD, Assmus M, Kiddoo D (2014) Symptomatic versus asymptomatic pyeloplasties: a single institution review. Can Urol Assoc J 8(11–12):428–431

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pérez-Marchán M, Pérez-Brayfield M (2022) Comparison of laparoscopic pyeloplasty vs. robot-assisted pyeloplasty for the management of ureteropelvic junction obstruction in children. Front Pediatr 10:1038454

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schuessler WW et al (1993) Laparoscopic dismembered pyeloplasty. J Urol 150(6):1795–1799

    Article  CAS  PubMed  Google Scholar 

  5. Gettman MT et al (2002) Anderson–Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology 60(3):509–513

    Article  PubMed  Google Scholar 

  6. Etafy M et al (2011) Robotic pyeloplasty: the University of California-Irvine experience. J Urol 185(6):2196–2200

    Article  PubMed  Google Scholar 

  7. Yu HY et al (2012) Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol 187(4):1392–1398

    Article  PubMed  Google Scholar 

  8. Minnillo BJ et al (2011) Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults. J Urol 185(4):1455–1460

    Article  PubMed  Google Scholar 

  9. Zappia JL et al (2023) Outcomes of robot-assisted laparoscopic pyeloplasty based on degree of obstruction on preoperative Tc-99 MAG-3 renal scintigraphy. J Endourol 37(2):151–156

    Article  PubMed  Google Scholar 

  10. Masieri L et al (2019) Robot-assisted pyeloplasty for ureteropelvic junction obstruction: experience from a tertiary referral center. Minerva Urol Nefrol 71(2):168–173

    Article  PubMed  Google Scholar 

  11. Liatsikos E et al (2022) Market potentials of robotic systems in medical science: analysis of the avatera robotic system. World J Urol 40(1):283–289

    Article  PubMed  Google Scholar 

  12. Avateramedical. https://www.avatera.eu/en/home. Accessed 21 June 2023

  13. Zhang P et al (2020) Robotic-assisted laparoscopic pyeloplasty as management for recurrent ureteropelvic junction obstruction: a comparison study with primary pyeloplasty. Transl Androl Urol 9(3):1278–1285

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rassweiler JJ et al (2017) Future of robotic surgery in urology. BJU Int 120(6):822–841

    Article  PubMed  Google Scholar 

  16. Peteinaris A et al (2023) The feasibility of robot-assisted radical cystectomy: an experimental study. World J Urol 41(2):477–482

    Article  PubMed  Google Scholar 

  17. Salkowski M et al (2023) New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology. Ther Adv Urol 15:17562872231177780

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tuo Z et al (2021) Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study. BMC Urol 21(1):159

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rasool S et al (2020) Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients. J Robot Surg 14(2):325–329

    Article  PubMed  Google Scholar 

  20. Dai X et al (2021) Comparison of KD-SR-01 robotic partial nephrectomy and 3D-laparoscopic partial nephrectomy from an operative and ergonomic perspective: a prospective randomized controlled study in porcine models. Int J Med Robot 17(2):e2187

    Article  PubMed  Google Scholar 

  21. Berguer R, Smith W (2006) An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res 134(1):87–92

    Article  PubMed  Google Scholar 

  22. Spampinato G et al (2021) Comparison of the learning curve for robot-assisted laparoscopic pyeloplasty between senior and junior surgeons. J Laparoendosc Adv Surg Tech A 31(4):478–483

    Article  PubMed  Google Scholar 

  23. van der Schans EM et al (2020) From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot. J Robot Surg 14(6):835–839

    Article  PubMed  PubMed Central  Google Scholar 

  24. Iranmanesh P et al (2010) Set-up and docking of the da Vinci surgical system: prospective analysis of initial experience. Int J Med Robot 6(1):57–60

    Article  PubMed  Google Scholar 

  25. Yanke BV et al (2008) Robot-assisted laparoscopic pyeloplasty: technical considerations and outcomes. J Endourol 22(6):1291–1296

    Article  PubMed  Google Scholar 

  26. Bentas W et al (2003) Da Vinci robot assisted Anderson–Hynes dismembered pyeloplasty: technique and 1 year follow-up. World J Urol 21(3):133–138

    Article  PubMed  Google Scholar 

  27. Carmona O et al (2022) Laparoscopic versus robot-assisted pyeloplasty in adults—a single-center experience. J Pers Med 12(10):1586

    Article  PubMed  PubMed Central  Google Scholar 

  28. Traumann M et al (2015) Robot-assisted laparoscopic pyeloplasty in adults: excellent long-term results of primary pyeloplasty. Urol A 54(5):703–708

    Article  CAS  Google Scholar 

  29. Nayyar R, Gupta NP, Hemal AK (2010) Robotic management of complicated ureteropelvic junction obstruction. World J Urol 28(5):599–602

    Article  PubMed  Google Scholar 

  30. Fan S et al (2021) Robot-assisted pyeloplasty using a new robotic system, the KangDuo-Surgical Robot-01: a prospective, single-centre, single-arm clinical study. BJU Int 128(2):162–165

    Article  PubMed  Google Scholar 

  31. Elorrieta V et al (2023) ROBOT assisted laparoscopic surgeries for nononcological urologic disease: initial experience with Hugo Ras system. Urology 174:118–125

    Article  PubMed  Google Scholar 

  32. Hussein AA et al (2023) Transition from da Vinci to Versius robotic surgical system: initial experience and outcomes of over 100 consecutive procedures. J Robot Surg 17(2):419–426

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The avatera system and all the disposable instruments were provided by avateramedical GmbH for the conduction of this clinical study.

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Department of Urology, University of Patras, Patras, Greece

    Panagiotis Kallidonis, Vasileios Tatanis, Angelis Peteinaris, Paraskevi Katsakiori, Kristiana Gkeka, Solon Faitatziadis, Athanasios Vagionis & Evangelos Liatsikos

  2. Department of Anesthesiology and ICU, University of Patras, Patras, Greece

    Theofanis Vrettos

  3. Department of Urology, University Hospital of Leipzig, Leipzig, Germany

    Jens-Uwe Stolzenburg

  4. Department of Urology, Medical University of Vienna, Vienna, Austria

    Evangelos Liatsikos

  5. Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece

    Evangelos Liatsikos

Authors
  1. Panagiotis Kallidonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vasileios Tatanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelis Peteinaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paraskevi Katsakiori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristiana Gkeka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Solon Faitatziadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Athanasios Vagionis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Theofanis Vrettos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jens-Uwe Stolzenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Evangelos Liatsikos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PK: protocol/project development, data collection or management, manuscript writing/editing. VT: data collection or management, data analysis, manuscript writing/editing. AP: data collection or management, data analysis, manuscript writing/editing. PK: data analysis, manuscript writing/editing. KG: data collection or management. SF: data collection or management. AV: data collection or management. TV: protocol/project development, data collection or management. J-US: protocol/project development, data collection or management. EL: protocol/project development.

Corresponding author

Correspondence to Evangelos Liatsikos.

Ethics declarations

Conflict of interest

Jens-Uwe Stolzenburg is co-founder, shareholder and medical advisor of avateramedical GmbH. Evangelos Liatsikos is medical advisor of avateramedical GmbH. The rest of the authors have no relevant financial or non-financial interests to disclose.

Compliance with ethical standards

The study has been carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Research involving human participants and/or animals

Ethical approval was waived by the Institutional Ethics Committee in view of the prospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Written informed consent was obtained from all the included patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kallidonis, P., Tatanis, V., Peteinaris, A. et al. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system. World J Urol 41, 3155–3160 (2023). https://doi.org/10.1007/s00345-023-04586-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-023-04586-7

Keywords

Search

Navigation