Abstract
Introduction:
In this video, we present robot-assisted laparoscopic reoperative repair of secondary ureteropelvic junction obstruction (UPJO) and demonstrate technicalities of repair. 1,2
Materials and Methods:
From March 2011 to February 2015, a total of six procedures were performed. This video demonstrates the surgical technique in an illustrative manner in an index case. The da Vinci Si robotic platform with the four-arm approach was used. The salient features includes (1) ureteric catheter placement, (2) four-port placement with patient in the lateral position, (3) bowel mobilization, (4) localization of lower calyx by intraoperative ultrasound probe, (5) lower polar segmental nephrectomy, (6) anastomosis with 3-0 V-loc sutures (other absorbable sutures such as polyglactin can be used avoiding the use of Hem-o-lok clips) over a preplaced 5F ureteric catheter and drain placement, and (7) changing of ureteral catheter to the Double-J stent on the third day postoperatively.
Results:
The procedures were completed in all the cases without any intraoperative complications. In the index case described, the operative time was 160 minutes and analgesic requirement was 192 mg of tramadol. There was no blood transfusion requirement. Urethral catheter was removed on the fifth postoperative day, drain on the sixth postoperative day, and stent after 6 weeks.
Conclusions:
Robot-assisted laparoscopic ureterocalicostomy for secondary UPJO is safe and feasible in expert hands. 3 Apart from the short recovery times, early mobilization, and decreased analgesic requirements, robotic approach provides the added advantage of technical ease and precision of suturing. 4
No competing financial interests exist
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Runtime of video: 6 mins 52 secs
Keywords
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