Robot-assisted laparoscopic pyeloplasty: technical considerations and outcomes

Since first being described in 1993, laparoscopic pyeloplasty has proven to be less morbid but equally as effective as open pyeloplasty. The technical complexity of the procedure, however, has made it difficult for many surgeons to adopt. The da Vinci robot-assisted laparoscopic pyeloplasty (RP) was introduced to shorten the learning curve. We present our institutional experience with RP.

Between October 2005 and September 2006, 29 RPs were performed and prospectively recorded in a database. The patient population consisted of 18 (62%) women and 11 (38%) men with a mean age of 41.2 years (range 17-82 years). Outcomes were retrospectively reviewed. Procedures were performed transperitoneally in a modified flank position using a 4-port template.

Mean follow-up was 11 months (range 6-17 months). Eighteen (62%) patients had ureteropelvic junction (UPJ) obstruction on the right, while 11 (38%) patients had obstruction on the left. Nine (31%) patients presented for secondary repair, all because of failed endopyelotomy. Mean operative time was 196 minutes (range 120-420 min), estimated blood loss was 39 mL (range 25-250 mL), and length of hospital stay was 2.2 days. Crossing vessels were encountered in 20 (69%) patients. Procedures in two patients, encountered early in our series, required open conversion. Both were secondary repairs after failed Acucise endopyelotomy. There were two readmissions, one for flank pain and another for pyelonephritis. There were no recurrences based on both subjective and radiologic measures.

We demonstrate that RP is a technically feasible management option for UPJ obstruction with success rates comparable to those of conventional laparoscopic and open pyeloplasty.