Abstract
Bilateral ureteropelvic junction (UPJ) obstruction occurs infrequently. When surgical management is deemed necessary, staged pyeloplasties traditionally have been recommended to minimize the morbidity associated with performing procedures concurrently. With the advent of robotic-assistance, concurrent surgical management can more readily be performed laparoscopically. In this report, we evaluated the safety and outcome of managing patients with bilateral UPJ obstruction with concurrent robotic-assisted laparoscopic pyeloplasty. We performed a retrospective review of five patients with bilateral ureteropelvic junction obstruction who underwent concurrent bilateral robotic-assisted pyeloplasties at our institution between October 2003 and April 2007. Technical consideration for patient positioning, robotic set-up, port placement, and the use of a hitch stitches was assessed. The operative time, complications, analgesic needs, length of hospitalization, and overall success of the procedure were evaluated. Operative time ranged from 235 to 541 minutes (mean = 384). Estimated blood loss was 5-100 cc (mean = 48.0). Length of hospitalization ranged from 1.3 to 3.6 days (mean = 2.4). Ureteral stents were removed 3-8 weeks postoperatively. There were no complications. All kidneys demonstrated decreased hydronephrosis on postoperative ultrasound or improved drainage parameters on diuretic renography or IVP. Simultaneous bilateral robotic-assisted laparoscopic pyeloplasties utilizing 4-port access is feasible and safe. It provides an effective method of managing patients with bilateral UPJ obstruction, avoiding the burden and morbidity of performing staged surgeries.
Highlights
IntroductionWhen surgical management is deemed necessary, staged pyeloplasties traditionally have been recommended to minimize the morbidity associated with performing procedures concurrently
Bilateral ureteropelvic junction (UPJ) obstruction occurs infrequently
Bilateral ureteropelvic junction obstruction is present in approximately 10-40% of UPJ obstructions [1,2]
Summary
When surgical management is deemed necessary, staged pyeloplasties traditionally have been recommended to minimize the morbidity associated with performing procedures concurrently. We evaluated the safety and outcome of managing patients with bilateral UPJ obstruction with concurrent robotic-assisted laparoscopic pyeloplasty. Conclusions: Simultaneous bilateral robotic-assisted laparoscopic pyeloplasties utilizing 4-port access is feasible and safe. It provides an effective method of managing patients with bilateral UPJ obstruction, avoiding the burden and morbidity of performing staged surgeries. While the success of performing concurrent bilateral open pyeloplasties has been reported [3], many surgeons remain hesitant to perform this procedure because of the morbidity associated with operating on both kidneys concurrently and the potential for acute bilateral renal obstruction. It requires the need for the patient to undergo two separate operations, which are separated by a potentially prolonged recovery period
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