Repositioning of Ureteropelvic Junction in Robot-assisted Laparoscopic Pyeloplasty

Abstract

ObjectiveTo describe the technique of ureteropelvic junction (UPJ) repositioning in robot-assisted dismembered pyeloplasty as a modified approach during which the UPJ is brought to a new location to facilitate the anastomosis. Materials and MethodsRetrospective review of pediatric and adult cases of robot-assisted laparoscopic pyeloplasty performed between the years 2016-2022. In a select group of patients, repositioning of the UPJ was performed. Demographic data, surgical and post-surgical outcomes was compared to a group that underwent classical AH dismembered pyeloplasty. ResultsOverall, 70 patients underwent robot-assisted laparoscopic dismembered pyeloplasty and were included in the study, with 15 in the repositioning group and 55 in the AH group. The median age of patients included was 26 months (IQR 7-203). Median operative time was 140 minutes (IQR 129-192) and 170 minutes (IQR 135-207) for the repositioning and AH group, respectively. The indications for UPJ repositioning were high UPJ insertion (n=8), crossing vessel (n=5) and renal malformations (n=2). Clinical significance was shown in SFU classification and split renal function postoperatively respectively (p<0.001;p<0.01). Postoperatively, both groups showed improvement in APD and diuretic T1/2 (p=0.48). There was one case of surgical failure requiring revisional surgery in the repositioning group (6.6%) and three in the AH group (5.5%) (p>0.05). Overall, there were three cases of Clavien-Dindo Grade 3 complications, all in the AH group (Two cases of urine leak from anastomosis, one case of port side hernia). ConclusionRepositioning of the UPJ is optional in cases when the obstructed UPJ is in a suboptimal anatomical position.