Case Report: Simultaneous Bilateral Robot-Assisted Dismembered Pyeloplasties for Bilateral Ureteropelvic Junction Obstruction: Technique and Literature Review

Abstract

Simultaneous bilateral laparoscopic renal operations are technically difficult and not often performed. We present our technique of bilateral simultaneous robot-assisted pyeloplasties for bilateral ureteropelvic junction (UPJ) obstruction, review the literature, and discuss the advantages of robot assistance in such cases. A 19-year-old man with bilateral congenital UPJ obstruction underwent bilateral simultaneous robotic pyeloplasties at our center. A transperitoneal approach was used with the patient in the lateral decubitus position and with repositioning and redraping between sides. A total of five ports was used: three in the midline, which were used for both sides, and an additional port in the iliac fossa on each side. Three arms of a four-arm da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) were used with four instruments. Antegrade 6F Double-J stents were placed on both sides. The procedure was completed in a total surgical time of 305 minutes. This included 30 minutes for robot docking/instrument error and 145 and 130 minutes of operating time for the right and left sides, respectively. The blood loss was <30 mL. There were five adverse haptic events: two incorrect suture placements and three suture breakages during knot-tying. The patient developed subcutaneous emphysema on the chest wall that resolved in 6 hours. He was allowed oral intake 6 hours after surgery, ambulated after 14 hours, and was discharged after 38 hours. Robotic assistance allows complex bilateral reconstructive laparoscopic operations to be performed in one session.