An increasing body of evidence supports robotic pyeloplasty (RP) as the primary contemporary treatment of ureteropelvic junction obstruction (UPJO). When UPJO is suspected, appropriate preoperative evaluation should confirm delayed drainage of the affected side, adequate ipsilateral renal function, and fully delineate other associated anatomic abnormalities. Optimal candidates for RP are healthy subjects with a documented abnormality on isotope renography or classic colic symptoms. Routine preoperative stenting is not necessary and retrograde pyelography is needed only if there is suspicion for distal obstruction. In a modified flank position, we utilize three robotic ports and one 5-mm assist port. A transmesenteric approach to the ureteropelvic junction (UPJ) can be advantageous, particularly in thin subjects, left-sided disease, and ectopia abnormalities. A percutaneous “hitch” stitch placed on the pelvis can be very helpful in facilitating dissection and the reconstruction. Concomitant transposition of a lower pole vessel or nephrolithotripsy is relatively straightforward to perform during RP. Intraoperatively, we pass a stent antegrade and leave it in place for 2-4 weeks. Patients usually are able to leave the hospital within 24 h of the procedure. Major complications are extremely rare. Accumulating series demonstrate the reproducibility and efficacy of RP, along with its related benefits of improved cosmesis and reduced convalescence. Although RP is associated with increased cost, the learning curve for RP appears to be shorter than for conventional laparoscopic pyeloplasty.
|Original language||English (US)|
|Title of host publication||Robotic Renal Surgery: Benign and Cancer Surgery for the Kidneys and Ureters|
|Number of pages||11|
|State||Published - Jan 1 2013|
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