Is retroperitoneal approach feasible for robotic dismembered pyeloplasty: initial experience and long-term results

To present our initial series of robotic-assisted retroperitoneal dismembered pyeloplasty in adults patients using the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA).

Ten adult patients with unilateral ureteropelvic junction (UPJ) obstruction underwent robotic-assisted retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty between February 2004 and March 2005. UPJ obstruction was primary in six patients and secondary in four patients after failed endopyelotomy. Dismembered pyeloplasty was performed utilizing a retroperitoneal approach (developed by balloon dissection). Three retroperitoneal laparoscopic ports were placed for the robot, and a fourth port was used by the assistant. Robotic-assisted laparoscopic technique was utilized to perform the entire procedure in all cases.

All cases (seven right, three left) were successfully completed using the robot without conversion to conventional laparoscopic or open technique. Median surgical time was 175 minutes (95% confidence interval [CI] 128-185), median estimated blood loss was 50 mL (95% CI, 26-62), and the median hospital stay was 48 hours (95% CI, 27-65). No complications occurred. At a mean follow-up of 30 months (range 24-36), clinical symptomatic assessment with a numeric pain scale, health-related quality of life evaluation with the Short Form 36 health survey, and functional assessment with Tc-99m-mercaptoacetyltriglycine, diuretic renography, and intravenous urogram demonstrated a successful outcome in all cases.

Robotic-assisted dismembered pyeloplasty can be performed efficiently by the retroperitoneal laparoscopic technique. Our surgical outcomes are comparable to previously published laparoscopic and transperitoneal robotic-assisted dismembered pyeloplasty series in adults with excellent clinical and radiologic success rates.