Abstract
Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci® surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci® surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruction. Peri-operative and outcome data were recorded prospectively. Twenty-four patients underwent RALPY over a 4-year period. The mean age was 46.6 (range 18–76) years. The mean total operative time was 211 min (range 150–317 min) with an anastomotic time of 44 min (range 30–55 min). The mean estimated blood loss was 56 ml (10–150 ml) and there was one temporary urine leak managed by 24 h of urethral catheterization. The median length of stay was 4 (2–10) days. Patients underwent diuretic renography at 6 months post surgery, and satisfactory renal drainage was demonstrated in all cases. RALPY is a feasible and safe option for the management of UPJ obstruction. This technology may reduce the difficulty associated with complex laparoscopic suturing and facilitate shorter operative times with excellent outcomes. This is now our preferred approach for all patients opting for surgical management of UPJ obstruction.
Similar content being viewed by others
References
Sung GT, Gill IS, Hsu TH (1999) Robotic-assisted laparoscopic pyeloplasty: a pilot study. Urology 53:1099–1103
Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG (2006) Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 67(5):932–936
Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR (2002) Laparoscopic pyeloplasty: the first 100 cases. J Urol 167(3):1253–1256
Canes D, Berger A, Gettman MT, Desai MM (2008) Minimally invasive approaches to ureteropelvic junction obstruction. Urol Clin North Am 35(3):425–439
Schwentner C, Pelzer A, Neururer R, Springer B, Horninger W, Bartsch G, Peschel R (2007) Robotic Anderson-Hynes pyeloplasty: 5-year experience of one centre. BJU Int 100:880–885
Bentas W, Wolfram M, Brautigam R, Probst M, Beecken WD, Jonas D, Binder J (2003) Da Vinci robot assisted Anderson-Hynes dismembered pyeloplasty. World J Urol 21:133–138
Gettman MT, Peschel R, Neururer R (2002) A comparison of laparoscopic pyeloplasty performed with the da Vinci robotic system versus standard laparoscopic techniques: initial clinical results. Eur Urol 42:453–457
O’ Malley PJ, Van Appledorn S, Bouchier-Hayes DM, Crowe H, Costello AJ (2006) Robotic radical prostatectomy in Australia: initial experience. World J Urol 24(2):165–170
Murphy D, Challacombe B, Elhage O, Khan MS, Dasgupta P (2008) Robotically assisted laparoscopic pyeloplasty. BJU Int 102(1):136–151
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 240:205–213
Symons SJ, Bhirud PS, Jain V, Shetty AS, Desai MR (2009) Laparoscopic pyeloplasty: our new gold standard. J Endourol 23(3):463–467
Link RE, Bhayani SB, Kavoussi LR (2006) A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 243(4):486–491
Braga LH, Pace K, Demaria J, Lorenzo AJ (2009) Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate. Eur Urol [Epub ahead of print]
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hall, R.M., Murphy, D.G., Challacombe, B. et al. Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience. J Robotic Surg 3, 209–213 (2010). https://doi.org/10.1007/s11701-009-0163-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-009-0163-5