Robotic Pyeloplasty

Abstract

The ureteropelvic junction obstruction (UPJO) is a well-known urologic disease. To cure this problem, a lot of different operations are available. The best long-term results are produced by the so-called dismembered Anderson/Hynes pyeloplasty which was first published in 1949; this technique is considered today as the gold standard.

Due to shortcomings of the access trauma of a flank incision which is traditionally used to reach the kidney, minimal invasive procedures, for example, the laparoscopic radical nephrectomy, were introduced in modern urology as a new standard of care.

In plastic reconstructive kidney surgery, Schüssler et al. performed in 1993 the first dismembered laparoscopic pyeloplasty. Since then there has been an increasing number of publications and a growing adaption of the minimally invasive version of the dismembered pyeloplasty. Nowadays, we find several publications confirming the feasibility and good functional results of the laparoscopic pyeloplasty, which are comparable to the results of open procedures. Unfortunately in all laparoscopic plastic reconstructive procedures, suturing and tissue handling are very difficult and lead to a long learning curve, prolonged operation times, and the effect of the procedure was not always available. To overcome these problems and still give the benefit of minimal invasive surgery to the patient (less blood loss, shorter hospital stay, less pain, and better cosmesis) while on the other hand keeping the very good long-term results, the robotic version of the pyeloplasty carried out with the da Vinci system (Intuitive Surgical, Sunnyvale, California) came in to play. Having all seven degrees of freedom for the instruments and a real three-dimensional view, this technical device can ease the learning curve for the procedure and still give excellent results to the patient.