Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience

Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci(®) surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci(®) surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruction. Peri-operative and outcome data were recorded prospectively. Twenty-four patients underwent RALPY over a 4-year period. The mean age was 46.6 (range 18-76) years. The mean total operative time was 211 min (range 150-317 min) with an anastomotic time of 44 min (range 30-55 min). The mean estimated blood loss was 56 ml (10-150 ml) and there was one temporary urine leak managed by 24 h of urethral catheterization. The median length of stay was 4 (2-10) days. Patients underwent diuretic renography at 6 months post surgery, and satisfactory renal drainage was demonstrated in all cases. RALPY is a feasible and safe option for the management of UPJ obstruction. This technology may reduce the difficulty associated with complex laparoscopic suturing and facilitate shorter operative times with excellent outcomes. This is now our preferred approach for all patients opting for surgical management of UPJ obstruction.