Abstract
Introduction:
The advantages of robot render robotic surgery ideal for complex reconstructive and ablative procedures. Robot-assisted pyeloplasty (RAP) is getting popular as a treatment alternative for ureteropelvic junction obstruction (UPJO). However, this operation may be challenging in complex cases of UPJO. In this video, we present RAP operation for UPJO due to double collecting system of the right kidney.
Materials and Methods:
The patient was a 28-year-old woman. Magnetic resonance imaging pyelogram showed a double collecting system and hydronephrosis in the lower pole on the right side. A retrograde pyelogram demonstrated similar findings. The diuretic renogram revealed obstruction with a prolonged t ½ half time. Three robotic and one assistant ports were placed transperitoneally. After mobilization of the colon, dilated lower pole pelvis was identified and dissected meticulously. The double collecting system draining into the single ureter was identified. Moreover, a crossing polar vein was seen around the UPJ. The dilated pelvis was incised and patulous part of the renal pelvis was excised. The incision was extended to upper collecting system. A side-to-side anastomosis was performed between two collecting systems. First, the posterior side of the anastomosis was completed. A Double-J stent was introduced down the ureter through the assistant trocar antegradely. Then, the anterior side of the anastomosis was started. The upper part of the anterior anastomosis was performed under the guidance of a ureteral catheter. A novel loop knot that was described by us before was used for fixation and strengthening of the anastomosis.
Results:
Total operative time was 170 min and estimated blood loss was 150 mL. Postoperative period was uneventful. Diuretic renogram showed unobstructed ureteropelvic junction at 3 months' follow-up.
Conclusions:
RAP is a feasible and effective treatment modality in complicated cases of UPJO. Robotic assistance simplifies dissection and suturing, thus resulting in ease of operation even in challenging pyeloplasty cases.
No competing financial interests exist.
Runtime of video: 6 mins 57 secs
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