Robotic Pyeloplasty: The Results after the First 30 Patients

Abstract

The aim of this paper is to report the outcomes of 30 (first) robot-assisted pyeloplasties (RPs) performed at our institute for the treatment of ureteropelvic junction obstruction (UPJO). In the period between March 2005 and September 2012, 30 RPs due to UPJO have been performed at our institute using a three arms Da Vinci Robot, standard version. All the procedures were performed transperitoneally with Anderson-Hynes technique. 29/30 (97%) patients were affected by primary UPJO and 1/30 (3%) reported a recurrent disease. The access foresaw the positioning of three robotic trocars (one 12 mm trocar for the camera and two 8-mm trocars for the robotic arms) and one assistant 12 mm trocar. The anastomosis was confectioned on a double-J ureteral tutor with 4/0 monocryl running sutures. Outcome success was defined as resolution of preoperative symptoms and ureteropelvic junction obstruction, confirmed by the improvement of the diuretic renogram. Mean follow-up was 48.3 months (range 5-96). All procedures have been completed robotically and no conversion was needed. Mean operative times, blood losses and hospital stay were respectively 189 minutes (range 105-420), 60 mL (range 25-100) and 4.2 days (range 2-14). 29/30 patients were cured, with a success rate of 97%. As regards mild complications, 3/30 patients (10%) reported a moderate abdominal pain a few hours after surgery, which was successfully treated with common analgesic drugs. A s for major complications, one patient (3%) developed ileus, probably due to a mild urine extravasation through the ureteropelvic suture, which spontaneously disappeared three days after surgery. RP seems to be a "new gold standard" in the treatment of UPJO. The three-dimensional versatility and the outstanding accuracy of robot-assisted intracorporeal suturing produced excellent results after the first procedures without requiring a previous 'sound' laparoscopic experience.