V1999 ROBOT-ASSISTED LAPAROSCOPIC RIGHT CALYCEAL DIVERTICULECTOMY

Abstract

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2010V1999 ROBOT-ASSISTED LAPAROSCOPIC RIGHT CALYCEAL DIVERTICULECTOMY Matthew Paszek, James Hoskins, and Ramakrishna Venkatesh Matthew PaszekMatthew Paszek More articles by this author , James HoskinsJames Hoskins More articles by this author , and Ramakrishna VenkateshRamakrishna Venkatesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Symptomatic renal calyceal diverticulum can be managed by ureteroscopic, percutaneous endoscopic, or laparoscopic approaches. Robotic assistance can facilitate the closure of the neck of the diverticulum and obliterate the diverticular cavity. This video demonstrates a technique to ablate renal calyceal diverticulum. A 35-year-old female with history of recurrent pyelonephritis underwent percutaneous drain placement for a suspected abscess. Further work-up revealed a calyceal diverticulum. After a failed ureteroscopic procedure, she was referred for definitive treatment. She presented to us with a perinephric drain and an indwelling ureteral stent. METHODS A retrograde ureteral catheter was positioned for pyelography and for later injection of indigo carmine to identify the diverticular neck. In view of the posterior upper pole location, an intermediate robotic camera position was chosen. Intra-operative laparoscopic ultrasound was performed to identify the diverticulum and to find the thin area of renal cortex overlying it. The diverticulum was entered sharply without clamping of the hilar vessels. Argon beam coagulator was used to fulgurate the lining. The neck of the diverticulum was oversewn and the diverticular cavity was obliterated by renorrhaphy using sliding clip technique with 10mm Hem-o-loks (Weck Closure Systems, NC, USA). RESULTS Total operative time was 220 minutes. Estimated blood loss was 100ml. Retrograde pyelography at the end of the case revealed no contrast entry into the previously seen diverticulum. Patient was discharged on post-operative day 2 with no evidence of urine leak (JP fluid creatinine was 0.7mg/dl). CONCLUSIONS Robot-assistance provided for easier access and reconstruction of the posterior upper pole of the kidney. The sliding clip renorrhaphy technique described for laparoscopic/robotic partial nephrectomy can be performed to obliterate the renal calyceal diverticular cavity. Lexington, KY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e776 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Paszek More articles by this author James Hoskins More articles by this author Ramakrishna Venkatesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...