Robotic-Assisted Approach in Relapsed Ureteropelvic Junction Obstruction

Abstract

Purpose Ureteropelvic junction syndrome (UPJS) is the most frequent cause of ureteral obstruction in children. Since our robotic experience starts in 2006 with da Vinci surgical system®, we initiate a series thinking about the benefits in terms of surgical precision and outcomes. We present the clinical case of a patient with relapsed ureteropelvic junction obstruction treated by means of a robotic-assisted approach Material and Methods We present a 21 years old patient with history of open right pyeloplasty at 9 years, who complains of right low back pain since several months. A renogram with obstructive pattern and an abdominal computed tomography (CT) with three-dimensional (3D) image reconstruction, reported a proximal ureteral stenosis secondary to a polar vessel. A robotic-assisted transperitoneal pyeloplasty is performed with the use of 3 robotic trocars and a 5 mm. trocar for the assistant. The ureteral suture is done using 6-0 Monocryl® Results Total surgical time was 180 minutes with a console time of 110 minutes. Blood loss was insignificant and patient was discharged 48 hours after surgery with a double J stent, which was removed 4 weeks later with sedative medication. A renogram indicated 3 months postoperatively conforms absence of obstruction. Conclusions Robotic approach allows a good surgical performance, comfortable for the surgeon with 3D vision; enabling an excellent dissection and reconstruction (anastomosis) in tissues already injured. The patient's recovery is fast with satisfactory esthetic and functional outcomes.