Robotic Pyeloplasty Step by Step

Abstract

Introduction:

Although open pyeloplasty has been the gold standard for management of ureteropelvic junction obstruction (UPJO), several options are available, including antegrade and retrograde endopyelotomy as well as laparoscopic and robotic pyeloplasty. Robotic pyeloplasty has developed into a successful approach to treat adults and children with UPJO. We present a detailed instructional video to demonstrate the individual steps of robotic pyeloplasty.

Materials and Methods:

A step-by-step account of our current surgical technique of robotic pyleoplasty is described in this video tutorial: retrograde pyelogram and placement of a ureteral stent; placement of trocars; isolation of the ureter; dissection of renal pelvis with placement of hitch stitch; mobilization of renal pelvis; spatulation of the ureter; reduction of renal pelvis; ureteral anastomosis; and/or removal of stone; closure of renal pelvis.

Results:

Tips that will aid in achieving optimal outcomes include complete mobilization of the renal pelvis, which is essential to provide a tension-free, water tight, mucosal to mucosal anastomosis. After mobilization, placement of a hitch stitch in the renal pelvis may facilitate stabilization of the anastomosis, particularly in the case of an intrarenal pelvis. In addition, spatulation of the ureter is best performed before complete transection. This step avoids spiraling of the spatulation. Successful Anderson-Hynes robotic dismembered pyeloplasty is a reproducible technique for surgical correction of UPJO. Success rates will be in the range of 96–99%. A crossing vessel is important to visualize, mobilize, and preserve in adult UPJO.

Conclusions:

Robotic pyeloplasty is a safe, feasible, and effectivez minimally invasive technique for treating UPJO. The standardization of each surgical step has improved the surgical outcomes utilizing a robot-assisted laparoscopic approach.

No competing financial interests exist.

Runtime of video: 5 mins 25 secs