Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair

Abstract

To review our experience of robotic redo pyeloplasty as a salvage procedure in previously failed repair of ureteropelvic junction (UPJ) obstruction. In one year, robot-assisted laparoscopic pyeloplasty was performed in nine patients for previously failed open pyeloplasty. Four of these patients had undergone additional retrograde endopyelotomy following failed repair, prior to being referred to us. The mean age was 16.4 years. All patients presented with persistent flank pain and an obstructive pattern on diuretic renogram. Robotic redo pyeloplasty could be performed successfully in all patients without any technical problems. Intraoperative findings for cause of UPJ obstruction were peri-ureteral fibrosis, narrow ureter, anterior crossing vessels, and redundant pelvis. The mean hospital stay was 3.4 days (2-5 days). All patients had improvement in symptoms and the nuclear scan showed non-obstructive drainage. Robot assisted redo pyeloplasty enables complex repair in patients with previous failed cases of UPJ obstruction repair. Three-dimensional magnified vision, and a dynamic articulated endowrist, allows fine dissection in the fibrosed area and precise suturing in an ergonomic fashion with a success equivalent to open surgery.