Robot-assisted Pyeloplasty Research Articles

Robotic Anderson–Hynes dismembered pyeloplasty: initial experience

The introduction of the da Vinci(®) robotic system in 2000 has been a new step forward in the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study was to analyse our initial experience with robot-assisted dismembered Anderson-Hynes pyeloplasty and to perform a bibliographic review on the topic. We performed 11 robot-assisted pyeloplasties between March 2007 and April 2011. UPJO diagnosis was made on clinical presentation and imaging techniques (CT scan and intravenous urography). All patients underwent basal and diuretic isotopic renograms to evaluate the degree of obstruction and impaired renal function. Median follow-up was 10 (range 1-26) months. Mean patient age was 38.8 (range 23-62) years. There were six women (55%) and five men (45%). All cases were primary surgeries. In four patients the cause of UPJO was a crossing vessel; the other seven patients had intrinsic obstruction. One case was associated with extraction of a calyceal lithiasis. Mean operative time was 189.4 min (125-270 min). Average time from robotic arms docking was 116.5 (range 55-180) min. Average hospital stay was 4.18 (range 2-8) days. Conversion to open or laparoscopic surgery was not necessary in any case and there were no postoperative complications. Postoperative radiological evaluation and renograms showed good results in all cases. Robotic surgery offers better ergonomics, enhanced three-dimensional (3D) vision and more precise movements, easing intracorporeal suturing.These advantages make robotic pyeloplasty a reproducible technique that combines the high success rates of open surgery and the benefits of laparoscopic surgery.

Cost Analysis of Pediatric Robot-Assisted and Laparoscopic Pyeloplasty

Cost Analysis of Pediatric Robot-Assisted and Laparoscopic Pyeloplasty

Robotic versus conventional laparoscopic pyeloplasty: A single surgeon concurrent cohort review

Introduction:The increasing availability of robotic devices has led to an increase in their use for procedures such as pyeloplasty, which have been conventionally performed laparoscopically or through open surgery. We perform both laparoscopic and robotic-assisted pyeloplasty routinely and have compared these techniques in a set of concurrent cohorts, operated by the same surgeon.Materials and Methods:A chart review was performed of all cases of Robot-assisted laparoscopic pyeloplasty (RALP) and conventional laparoscopic pyeloplasty (CLP) performed by a single surgeon, from September 2006 to July 2010. The choice of procedure depended upon the availability of the robot on the given day. A lateral transperitoneal approach was used in all cases. All anastomoses were stented antegrade. A diuretic renogram was obtained in all patients between six to twelve weeks after stent removal. Success was defined as a resolution of symptoms with non-obstructive outflow on the renogram.Results:Thirty patients underwent 31 laparoscopic pyeloplasties (20 RALPs and 11 CLPs), with one patient undergoing bilateral simultaneous robotic procedures. The robotic procedures were superior in terms of shorter operating time by 20 minutes on an average. Furthermore, 35% of the robotic procedures were performed in under 90 minutes, while the minimum time taken for laparoscopy was 110 minutes. All procedures in both cohorts were successful with no complications in either group. The surgeon recorded subjective ergonomic benefits with the use of the robot.Conclusions:Robotic assistance helps decrease the operative time for laparoscopic pyeloplasty. It seems ergonomically superior for the surgeon, allowing multiple procedures in the same list. These may be important benefits in busy centers.

Robotic-Assisted Pyeloplasty:Recent Developments in Efficacy, Outcomes, and New Techniques

Within the last decade, the adaptation of robotic urologic surgery has had a profound impact on surgical practice, with robotic upper tract reconstruction for ureteropelvic junction obstruction gaining rapid acceptance. Recent advances in robotic reconstruction demonstrate efficacious outcomes of robotic pyeloplasty, as compared with conventional laparoscopic pyeloplasty, even in the case of secondary surgery. Furthermore, efforts to continue to reduce the morbidity of laparoscopic surgery have led to the development and implementation of laparoendoscopic single-site (LESS) surgery. The recent applications of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has demonstrated the potential to further decrease morbidity, improve surgeon ergonomics, and improve cosmesis.

Pediatric Standard and Robot-Assisted Laparoscopic Pyeloplasty: A Comparative Single Institution Study

We report our experience and compare the outcomes between standard and robot-assisted laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in children. A retrospective cohort study was performed of all children who underwent standard or robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction at a single institution from October 2007 to January 2012. Indications for surgery included symptomatic obstruction and abnormal diuretic renal scan. A successful outcome was defined as resolution of clinical symptoms, improvement of hydronephrosis on ultrasound, stable ultrasound with resolution of symptoms or improvement of the drainage curve on diuretic renal scan. We reviewed 18 patients (median age 8.1 years) who underwent standard and 46 (8.8 years) who underwent robot-assisted laparoscopic pyeloplasty (p = 0.194). Median operative time was 298 minutes (range 145 to 387) for standard and 209 minutes (106 to 540) for robot-assisted laparoscopic pyeloplasty (p = 0.008). Mean hospitalization was similar between the groups (1 day for standard vs 2 days for robot-assisted laparoscopic pyeloplasty, p = 0.246). Narcotic use was similar between the groups. Median followup was 43 months for standard and 22 months for robot-assisted laparoscopic pyeloplasty (p <0.01). Renal ultrasound showed postoperative improvement of hydronephrosis in 85% and stable disease in 15% of patients following robot-assisted laparoscopic pyeloplasty, and improvement in 89.5% and stable disease in 10.5% after standard laparoscopic pyeloplasty. Symptoms resolved in 100% of patients (38 of 38) after robot-assisted laparoscopic pyeloplasty and 87.5% of patients (7 of 8) after standard laparoscopic pyeloplasty. Robot-assisted laparoscopic pyeloplasty and standard laparoscopic pyeloplasty are effective techniques to correct ureteropelvic junction obstruction, with similar outcomes. Robot-assisted laparoscopic pyeloplasty had a shorter operative time, and its success and complication rates are comparable to standard laparoscopic pyeloplasty.

Navigating the Difficult Robotic Assisted Pyeloplasty

Pyeloplasty is the gold standard therapy for ureteropelvic junction obstruction. Robotic assisted pyeloplasty has been widely adopted by urologists with and without prior laparoscopic pyeloplasty experience. However, difficult situations encountered during robotic assisted pyeloplasty can significantly add to the difficulty of the operation. This paper provides tips for patient positioning, port placement, robot docking, and intraoperative dissection and repair in patients with the difficult situations of obesity, large floppy liver, difficult to reflect colon (transmesenteric pyeloplasty), crossing vessels, large calculi, and previous attempts at ureteropelvic junction repair. Techniques presented in this paper may aid in the successful completion of robotic assisted pyeloplasty in the face of the difficult situations noted above.

Cost Analysis of Pediatric Robot-Assisted and Laparoscopic Pyeloplasty

An increasing percentage of pediatric pyeloplasties are being performed with assistance of the da Vinci® Surgical System. A review of the recent literature shows decreased operative times and length of hospital stays when robotic procedures are performed, although there are few published data comparing the cost of pediatric robotic and pure laparoscopic pyeloplasty. We reviewed a representative sample of pyeloplasties performed at our institution and performed a cost analysis. We retrospectively identified 23 robot-assisted and 23 laparoscopic pyeloplasties performed at our institution between August 2008 and April 2012. Total cost was calculated from direct and indirect costs provided by our billing department. Robotic procedures were shorter than pure laparoscopic procedures (200 vs 265 minutes, p <0.001) but there was no significant difference in the total cost of the 2 procedures ($15,337 vs $16,067, p <0.46). When compared to laparoscopic cases, subgroup analysis demonstrated decreased operative times (140 vs 265 minutes, p <0.00001) and total cost ($11,949 vs $16,067, p <0.0001) in robotic cases where stents were placed in an antegrade fashion. With widespread use the cost of robotic instrumentation may decrease, and experience may further shorten operative times. However, it currently remains to be seen whether robotic technology will become a cost-effective replacement for pure laparoscopy in the management of pediatric ureteropelvic junction obstruction.

Analysis of a large single‐center experience with robot‐assisted pyeloplasty

To report a single-center experience with robot-assisted pyeloplasty. Medical records of 100 consecutive robot-assisted pyeloplasty cases carried out between May 2004 and August 2010 were retrospectively reviewed, and major perioperative parameters were recorded. Patients underwent functional (renal scan) and/or anatomical (ultrasound or computerized tomoghraphy) imaging at 6 months. The mean patient age was 39.8 years. A total of 12 patients underwent prior attempts at repair. Ureteral stents were placed in all patients except one, and closed-suction drains were placed in 59 patients. There were two intraoperative complications and two postoperative complications requiring surgical intervention. One patient with a complex prior surgical history developed a urine leak that was managed with prolonged drainage. A total of 42 patients were discharged on postoperative day 1, and 44 were discharged on postoperative day 2. Mean length of follow up was 22.8 months. The operative success rate was 96%. The majority of patients undergoing robot-assisted pyeloplasty can expect a short hospitalization with minimal morbidity. The operative success rate is high, even in patients with prior attempts at repair. Complication rates including urine leaks are quite low, and routine placement of a closed-suction drain is likely to be unnecessary.

Cost Comparison of Robot-Assisted and Laparoscopic Pyeloplasty

Laparoscopic repair of ureteropelvic junction obstruction is now the standard of care at many institutions. The objective of this study is to compare costs associated with robot-assisted pyeloplasty (RP) vs laparoscopic pyeloplasty (LP). A decision analysis model was developed to compare costs of each procedure based on hospital-related cost centers. A literature search was performed to identify nonoverlapping studies with outcomes for RP and LP. Weighted means were calculated for operative time and length of stay. Cost data were obtained from our institution. One- and two-way sensitivity analyses were performed to evaluate the effect of changing variables on the cost-effectiveness of RP. Eight studies were identified with 181 and 145 patients undergoing RP or LP, respectively. Operative times were 211 minutes for RP and 224 minutes for LP. Hospital stays were shorter for RP at 1.54 days compared with 1.98 days for LP. Mean direct costs were higher for RP at $10,635 vs $9,065 for LP. The largest difference was in fixed surgical supply costs per case at $1357 for RP and $406 for LP. One-way sensitivity analysis showed that RP would be cost effective if performed in less than 96 minutes. Even if RP was performed on an outpatient basis or more than 1000 cases/year, however, LP would still be cost superior. Two-way analyses showed areas where RP could be more cost-effective than LP. RP is associated with higher cost compared with LP, predominately because of the cost of the robot and surgical supply costs. Decreasing operative time and equipment costs may result in RP being more cost-effective than LP. Shorter hospital stay alone, however, is insufficient to allow RP to be cost-effective. One would need to demonstrate tangible advantages to the robot to justify the added costs.

V538 ROBOT-ASSISTED PYELOPLASTY IN A PELVIC KIDNEY

You have accessJournal of UrologyPediatrics1 Apr 2012V538 ROBOT-ASSISTED PYELOPLASTY IN A PELVIC KIDNEY Frank J. Penna, Wooju Jeong, and Jack S. Elder Frank J. PennaFrank J. Penna Detroit, MI More articles by this author , Wooju JeongWooju Jeong Detroit, MI More articles by this author , and Jack S. ElderJack S. Elder Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.612AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of robot-assisted laparoscopic surgery is rapidly expanding, particularly within the field of pediatric urology. Various techniques have been shown to be feasible and as equipment and techniques improve, more complex reconstructive procedures may be attempted. For the current application, this surgical technique demonstrates the versatility of the robotic surgical system with variations in both patient size and anatomy. We report a robot-assisted procedure for a patient with an ectopically located pelvic kidney. METHODS The patient is an 11-month-old boy who was initially referred for urological evaluation at 2 weeks of age for prenatally detected hydronephrosis in a pelvic kidney. On postnatal work-up, the diagnosis of high-grade ureteropelvic junction obstruction was confirmed. The patient was a candidate for surgical intervention. The procedure began with cystoscopy, bilateral retrograde pyelography and left ureteral stent placement. A left retrograde pyelogram revealed a left-sided hydronephrotic kidney in the pelvis, just right of the midline. Using a tag, the location of the pelvic kidney was identified and labeled on the patient's abdomen to assist in directing proper port placement for the robot-assisted pyeloplasty. RESULTS The patient tolerated the procedure well. There were no complications. The patient was discharged on postoperative day 1 after adequate pain control without intravenous pain medication, return of bowel function, and complete bladder emptying. Follow-up ultrasound was normal. CONCLUSIONS Robot-assisted pyeloplasty is a safe and viable option for patients with an ectopically located pelvic kidney. The use of retrograde pyelography is essential in localizing the pertinent anatomy and for proper port placement and docking. The benefits of this procedure are manifold: patients are discharged sooner, the procedure is safe and efficacious and also offers benefits associated with minimally invasive surgery: less pain, morbidity with a potentially rapid recovery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e221 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frank J. Penna Detroit, MI More articles by this author Wooju Jeong Detroit, MI More articles by this author Jack S. Elder Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

7 ARE THERE DIFFERENCES IN OUTCOME OF LAPAROSCOPIC AND ROBOT ASSISTED PYELOPLASTIES AND HOW LONG IS STENTING OF THE ANASTOMOSIS NECESSARY?

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 20127 ARE THERE DIFFERENCES IN OUTCOME OF LAPAROSCOPIC AND ROBOT ASSISTED PYELOPLASTIES AND HOW LONG IS STENTING OF THE ANASTOMOSIS NECESSARY? Hansjoerg Danuser, Patrick Stucki, Giovanni B. di Pierro, and Agostino Mattei Hansjoerg DanuserHansjoerg Danuser Luzern, Switzerland More articles by this author , Patrick StuckiPatrick Stucki Luzern, Switzerland More articles by this author , Giovanni B. di PierroGiovanni B. di Pierro Luzern, Switzerland More articles by this author , and Agostino MatteiAgostino Mattei Luzern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.049AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study to analyse our consecutive series of 86 patients with ureteropelvic junction obstruction (UPJO) treated by laparoscopic (LPP) or robot assisted laparoscopic (RALPP) pyeloplasty and to answer 2 questions: 1. Are there differences in outcome after LPP and RALPP. 2. Are there differences in outcome by stenting of the pyeloplasty for 1 compared to 4 weeks. METHODS 86 patients were planned to undergo LPP (34) or RALPP (52). Preoperative work-up included an IVU or CT-Scan, a diuretic renography (DR) and a retrograde ureteropyelography followed by insertion of a 6 Fr JJ-stent as a preparatory procedure. Technically we performed a dismembered pyeloplasty (Anderson Hynes). A bladder catheter was left for 2 days after surgery. The JJ-stent was removed according to a prospective randomization after 1 or 4 weeks. Follow-up controls included an IVU 3 months, a DR 6 months and an ultrasound 1,3, 5 year postoperatively. RESULTS Preoperative data of the LPP- and the RALPP-series as well as the series stented for 1 and 4 weeks were comparable. In 4 patients (3 LPP and 1 RALPP) the intervention had to be converted to a successful open procedure, due to extensive abdominal scarring (3) or a scarred shortened ureter after unsuccessful endopyelotomy (1). Therefore 31 LPP- and 51 RALPP-patients were analyzed and the results presented in the following table. Results Surgery time (min) Hosp. time (days) Minor complications () Patency UPJ () Split renal function () Residual symptoms () LLP(n=31) 272±64 7.3±2.8 16 100 39±12 10 RALPP(n=51) 207±54 5.1±1.5 6 100 45±10 4 p-value <0.001 <0.001 0.16 1 0.04 0.3 In the randomized trial to stent the anastomosis 1 or 4 weeks, 33 and 31 patients were analysed. There was no significant difference in outcome of the groups stented for 1 or 4 weeks regarding complications, patency of the UPJ, split renal function and residual symptoms. CONCLUSIONS LPP and RALPP are safe and minimally invasive procedures with excellent success rates. Time of intervention and hospitalization seem to be shorter in the RALPP series. Stenting of the UPJ-anastomosis for 1 week is sufficient. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e3 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hansjoerg Danuser Luzern, Switzerland More articles by this author Patrick Stucki Luzern, Switzerland More articles by this author Giovanni B. di Pierro Luzern, Switzerland More articles by this author Agostino Mattei Luzern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intracorporeal Antegrade and Retrograde Stenting During Robot-Assisted Urinary Tract Reconstruction: Is It the Ideal Choice?

Introduction and Objective: One of the pertinent steps in many urologic reconstructive procedures is the placement of a stent across the repair. With regard to upper urinary tract reconstruction, many surgeons perform this step cystoscopically and place the stent in a retrograde fashion. Herein, we present our simplified, efficient, and cost-saving technique of Double-J (JJ) stent placement intracorporeally during robot-assisted upper urinary tract reconstructive surgery. Methods: With Institutional Review Board's approval, we queried our database of robotic procedures to identify those reconstructive operations that involved intracorporeal JJ stent placement since 2008. We describe our step-by-step technique for intracorporeal JJ stent placement during robot-assisted pyeloplasty, pyelolithotomy, and upper, mid, and lower ureteral reconstructive surgeries. Briefly, the floppy tip of a guide wire is passed through the open end of the JJ stent until it straightens out the stent. After a certain amount of the reconstruction has been performed, the stent is advanced intracorporeally through the assistant port. The console surgeon utilizes the robotic instruments to manipulate the stent into the ureter or other desired location. Once the stent has been adequately placed, it is stabilized with the robotic instruments while the guide wire is removed. A variety of techniques are employed for specific reconstructions to manipulate the stent into the desired position. Results: In the last 3 years, we have used this approach in 150 patients. Mean time of insertion was ∼3.5 minutes. In 3 patients, postoperative kidney, ureter, and bladder radiograph demonstrated that the stent had migrated proximally into the ureter. As these patients did not have any discomfort and the stent still spanned across the reconstructed anastomosis, we chose not to reposition the stent. In these 3 patients, the stent was removed ureteroscopically at the appropriate time, without any sequela. Conclusions: The described intracorporeal stenting technique during robotic urologic reconstructive procedures is efficient, cost-effective, and relatively simple to master. There is no need for patient repositioning, cystoscopy, or fluoroscopy, thereby avoiding increased operative time, cost, and radiation exposure. In upper tract robotic reconstructive surgery, intracorporeal JJ stenting should be the ideal choice. No competing financial interests exist. Runtime of video: 6 mins 27 secs

Analysis of Robotic-assisted Laparoscopic Pyleloplasty for Primary Versus Secondary Repair in 119 Consecutive Cases

To analyze the outcomes of our robotic-assisted pyeloplasty series for primary ureteropelvic junction obstruction (UPJO) and compare them with our series of robotic-assisted pyeloplasty for secondary UPJO. The repair of secondary UPJO can pose additional challenges to surgeons. Robotic assistance could aid in these repairs. Using an institutional review board-approved database, we reviewed 119 consecutive patients who had undergone robotic-assisted laparoscopic pyeloplasty at our institution during an 8-year period (May 2002 to February 2010). Data were collected in a combined retrospective and prospective manner. The patients were stratified into primary repair and secondary repair for the primary analysis. The patients were also stratified into those with stones and those without stones for the secondary analysis. We compared the demographic, operative, postoperative, and radiographic outcomes. Student's t test and Pearson's chi-square correlation were used for statistical analysis of continuous and categorical variables, respectively. Of the original 119 patients, data were available for 117. Of the 117 patients, 97 had undergone primary pyeloplasty repair and 20 had undergone secondary pyleloplasty repair. Radiographic data were available for 84 patients with primary repair and 17 patients with secondary repair. The radiographic success rate was 96.1% and 94.1%, respectively. No statistically significant differences were found in the patient demographics, operative data, or postoperative or radiographic outcomes for the primary analysis. Additionally, no differences were found in the outcomes for patients with concomitant stone disease. These data represent the largest single-center report of its kind. These data strongly suggest that robotic-assisted laparoscopic pyeloplasty is a safe and durable option for secondary UPJO repair.

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO). To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis included patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications. Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42); 32 were female. Most patients were diagnosed with preoperative diuretic renal scintigraphy and the obstructed side demonstrated mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as the need of another procedure due to persistent pain and/or obstruction after diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred. RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success rate for the treatment of primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.

Outcomes of Robot-Assisted Laparoscopic Pyeloplasty in Children: A Single Center Experience

Open pyeloplasty is the standard treatment for ureteropelvic junction obstruction in children. The introduction of robotic surgical system has facilitated precise intracorporeal suturing and shortened the learning curve for minimal invasive procedures for the surgeons. There is sparse data over the outcomes of robot-assisted laparoscopic pyeloplasties in children. We describe our technique and outcomes of robotic pyeloplasty in children. Operative data for all patients undergoing a robot-assisted procedure at our center is prospectively recorded in a database. We retrieved data of patients below the age of 16 years undergoing robot-assisted pyeloplasty between July 2007 to March 2011 and evaluated their operative parameters, recovery, and functional outcomes. In the period under review, 34 pediatric patients (mean age 12 years, range 5-15 years) underwent robot-assisted laparoscopic pyeloplasty at our center. All patients underwent unilateral pyeloplasty but one patient underwent a simultaneous contralateral pyelolithotomy. The mean total operative time (range) was 105 minutes (75-190 minutes), average dissection time and the anastomosis time was 23 minutes (20-58 minutes) and 46.5 minutes (28-70 minutes) respectively. The mean blood loss was 30 mL. Follow-up of 36, 24, 18, 12, and 6 months was completed in 14, 21, 24, 28, and 31 patients respectively. Postoperatively, one patient had an omentum herniation through the camera port site and another had an ileocaecal volvulus. With a mean follow-up of 28.5 months (2-56 months), the success rate was 97% (32/33), whereas postoperatively one patient had deterioration of function. Robot-assisted laparoscopic pyeloplasty is a safe and effective minimally invasive treatment modality in children.

Transmesocolic Robot-Assisted Pyeloplasty

Abstract Introduction and Objectives: Robot-assisted pyeloplasty results are comparable to those of open pyeloplasty, the standard option for ureteropelvic junction obstruction (UPJO), and it shows...

Comparison of the operation time and complications between conventional and robotic-assisted laparoscopic pyeloplasty

ObjectiveTo compare the different times into which the convention and robotic-assisted laparoscopic pyeloplasty can be divided. To compare the rate of complications between both procedures. Material and methodsA retrospective study was performed of the patients diagnosed with pyeloureteral junction stenosis and treated with convention and robotic laparoscopic pyeloplasty with more than one year of follow-up. All of the interventions were recorded and visualized. The different times in which the pyeloplasty can be divided were measured. All of the peri- and post-operative complications that occurred in the patients were collected. The non-parametric tests of Kolmogorov–Smirnov and Mann–Whitney U-test for independent samples were applied using a significance level of 0.05. ResultsA total of 50 patients were validated. Thirty three were treated with convention laparoscopy and, 17 with robotic laparoscopy. The suture time, total intervention time and time of hospital stay were lower with a statistically significant difference in the robotic-assisted pyeloplasty. The robotic pyeloplasty had a lower percentage of complications (76.5% vs. 48.5%). The most frequent complications were urinary infections, in relation to the double J. Two restenoses occurred in the conventional laparoscopy and one in the robotic-assisted. The success rate was 93.9% for the conventional laparoscopy and 94.1% for the robotic-assisted one. ConclusionsAlthough the success rate is similar in both procedures, the robotic pyeloplasty is a very fast procedure and has lower rates of complications than the conventional laparoscopy.

26 Feasibility of robot-assisted pyeloplasty with reduced number and size of ports

26 Feasibility of robot-assisted pyeloplasty with reduced number and size of ports

A minimal invasive surgical approach for children of all ages with ureteropelvic junction obstruction

ObjectiveOpen dismembered pyeloplasty is considered the gold standard to treat ureteropelvic junction obstruction (UPJO) in children. Laparoscopic pyeloplasty (LP) and robot-assisted pyeloplasty (RAP) are increasingly popular. Our present protocol consists of using minimally invasive techniques for all children with UPJO. Here, we report our first 40 cases operated under this protocol. Patients and methodsRetrospective chart review of patients who underwent LP and RAP for UPJO between 2006 and 2010 was performed. Children younger than 4 years of age underwent LP and children aged 4 years and older with robot assistance. Results were assessed comparing pre- and postoperative imaging studies, operating time, hospital course and complications. ResultsThirty-nine patients underwent 41 dismembered pyeloplasties (20 patients LP, 19 patients RAP). No conversions to open surgery were performed. The difference in operative time was statistically significant. The average hospital stay was 7 days (LP) and 6 days (RAP). All patients showed significant decrease of hydronephrosis and the overall success rate was 100%. The complication rate was 25% in the LP and 28% in the RAP group. ConclusionOur data show that RAP and LP are effective to correct UPJO with similar outcomes and complication rates. None of the patients in this series required re-intervention to correct obstruction and the results are comparable with open surgery.

Comparación del tiempo operatorio y complicaciones entre la pieloplastia laparoscópica convencional y robótica

Objective To compare the different times into which the convention and robotic-assisted laparoscopic pyeloplasty can be divided. To compare the rate of complications between both procedures. Material and methods A retrospective study was performed of the patients diagnosed of pyeloureteral junction stenosis and treated with convention and robotic laparoscopic pyeloplasty with more than one year of follow-up. All of the interventions were recorded and visualized. The different times in which the pyeloplasty can be divided were measured. All of the peri- and post-operative complications that occurred by the patients were collected. The non-parametric tests of Kolmogorov-Smirnov and Mann-Whitney U-Test for independent samples were applied using a significance level of 0.05. Results A total of 50 patients were validated. Thirty three were treated with convention laparoscopy and 17 with robotic laparoscopy. The suture time, total intervention time and time of hospital stay were lower with a statistically significant difference in the robotic-assisted pyeloplasty. The robotic pyeloplasty had a lower percentage of complications (76.5% vs 48.5%). The most frequent complications were urinary infections, in relationship to the double J. Two restenoses occurred in the conventional laparoscopy and one in the robotic-assisted. Success rate was 93.9% for the conventional laparoscopy and 94.1% for the robotic-assisted one. Conclusions Although the success rate is similar in both procedures, the robotic pyeloplasty is a very fast procedure and has lower rates of complications than the conventional laparoscopy.