Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system

Gettman, Matthew T.; Neururer, Richard; Bartsch, Georg; Peschel, Reinhard

doi:10.1016/s0090-4295(02)01761-2

Cited by 217 publications

(112 citation statements)

References 18 publications

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“…The goal of advanced robotic systems is improved operative technique and simplified suturing. Initial reports of robotic LP in pigs were published by Sung et al [21] and in humans by Gettman et al [22] . While these initial reports show the feasibility of robotic LP several limitations remain.…”

Section: Robotic Pyeloplastymentioning

confidence: 99%

Laparoscopic pyeloplasty: the first decade

2004

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ports introduced to enable dissection and identification of the PUJ. The technical principles and goals are similar to those of open surgery. Depending on the type of procedure the PUJ is either incised or dismembered, and reductive pyeloplasty performed if indicated. The ureteric JJ stent is typically inserted retrogradely before (the authors' preference being 4.7 F, 26 cm) or during surgery. A drain is inserted to lie adjacent to the completed repair and a Foley catheter is left in the bladder.Patients typically commence free oral intake of fluids 8-12 h after surgery; the urethral catheter is removed after 1-2 days and the wound drain subsequently. The ureteric stent is typically removed by outpatient flexible cystoscopy at 4 weeks, after IVU. RESULTSThe results of LP are shown in Table 1 [4][5][6][7][8][9][10]; several early reports were excluded where updated results from the same institution were published more recently. Several points are worth specific comment. The success rates of LP are consistently high, at 87-98%; the rates are > 95% in series with a predominance of primary procedures, with only one exception. The 'success rate' is defined as the objective radiological success, i.e. with a patent and unobstructed PUJ (or an improvement in drainage) by either IVU or diuretic renography. Subjective improvement rates, e.g. from patient questionnaires, are invariably less than the radiological success rates by 10-30% for both open and endourological pyeloplasty. There are several possible reasons for this discrepancy, but the present discussion focuses on the objective radiological success rate, which is reported rather more consistently. The prolonged operative duration of reconstructive laparoscopy is significant, but there has been a trend towards a reduction, from a mean of 330 min in the original series to 164-252 min in contemporary series reported in the last 3 years [6][7][8][9]11]. This reflects increased confidence and ability in intracorporeal suturing and knot-tying. Laparoscopic suturing and knot-tying can be learned effectively and reinforced by regular repetition in a 'dry lab' environment. The effect of increasing experience is notable, with an experienced laparoscopist consistently performing the entire procedure (transperitoneal) in < 3.5 h [9]. The retroperitoneal approach (mean operative duration 175 min) is seemingly quicker than the transperitoneal approach (mean 246 min) in contemporary series reported since 2001. This is probably because it takes less time to dissect and identify the PUJ with the retroperitoneal technique. The low morbidity of LP is well reflected in the low incidence of complications during and after surgery even in the initial series. The risks of blood transfusion are remarkably low, being limited to anecdotal reports, in sharp contradistinction to endopyelotomy, where the transfusion rates are 3-11%. The hospital stay is short, averaging 3.8 days in the series reported since 2000.To our knowledge there has been at least one abortive attempt to compare laparosc...

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Section: Robotic Pyeloplastymentioning

confidence: 99%

Laparoscopic pyeloplasty: the first decade

2004

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“…2,5,6 İlk kez 1999 yılında tanımlanan ve ilk serisi 2002 yılında Gettman tarafından yapılan RYLP; yüksek maliyetine rağmen üç boyutlu büyütmeli görüntü, enstrüman hareketlerindeki yüksek derece özgürlük, titreme filtresi, el-göz-hedef aksının korunması gibi avantajları sayesinde piyeloplastide çok önemli olan sütür uygulamalarını kolaylaştır-mış ve ÜPBD tedavisinde etkin ve güvenilir bir yöntem hâline gelmiştir. 2,6,9,[21][22][23] Retroperitoneal ve transperitoneal yöntem-lerle LP ve RYLP gerçekleştirilebilmektedir. Başarı oranı her iki yöntemde de aynı olmakla birlikte, intraabdominal organ hasarı riski retroperitoneal yaklaşıma göre daha yüksek olmasına rağmen; yeterli cerrahi alan sağlaması, aberran damarları daha iyi tespit etme imkânı ve anastomozu kolaylaştırma avantajları nedeni ile transperitoneal yaklaşım daha çok tercih edilir hâle gelmiştir.…”

Section: Discussionunclassified

Robot Assisted Laparoscopic Transmesocolic Right Pyeloplasty: Case Report

Demirer¹,

Fırat²,

Başal³

et al. 2015

Turkiye Klinikleri J Urology

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“…The da Vinci surgical robot is endowed with features that simplify intracorporeal reconstruction and suturing, effectively shortening the learning curve for residents, clinical fellows and other novice laparoscopists alike. 5,6 The first clinical experience with RALP in humans was reported in 2002 by Gettman and colleagues, 18,19 and provided acceptable short-term outcomes in a small number of patients. Since then, several other groups have reported similar satisfactory results as the body of literature continues to expand ( Table 1).…”

Section: Pyeloplastymentioning

confidence: 99%

Robotic renal surgery: The future or a passing curiosity?

Warren

Silva

Caumartin

et al. 2013

CUAJ

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The development, advancement and clinical integration of robotic technology in surgery continue at a staggering pace. In no other discipline has this rapid evolution occurred to a greater degree than in urology. Although radical prostatectomy has grown to become the prototypical application for the robot, the role of the robot in renal surgery remains controversial. Herein we review the literature on robotic renal surgery. A comprehensive PubMed literature search was performed to identify all published reports relating to robotic renal surgery. All clinically related articles involving human participants were critically appraised in this review. Fifty-one clinical articles were included, encompassing robot-assisted pyeloplasty, nephrectomy, nephroureterectomy, living-donor nephrectomy and partial nephrectomy. Feasibility has been shown for each of these procedures. Robot-assisted techniques have been described for almost all renal-related procedures. However, the intersect between feasibility and necessity as it pertains to robotic renal surgery has yet to be defined. Also, the high cost of surgical robotic technology mandates critical appraisal before adoption, especially in a publicly funded health care system, such as the one present in Canada. RésuméLe développement, le perfectionnement et l'intégration en milieu clinique de la technologie robotique en contexte opératoire se poursuit à un rythme stupéfiant. Aucune autre discipline n'a vu cette évolution rapide à un niveau aussi élevé que l'urologie. Alors que la prostatectomie radicale en est devenue l'application prototype, le rôle de la robotique en chirurgie rénale demeure controversé. Dans l'article qui suit, nous passons en revue la littérature portant sur l'emploi de la robotique en chirurgie rénale. Une recherche exhaustive dans la base de données PubMed a été effectuée afin de cerner les rapports sur le sujet. Tous les rapports cliniques portant sur des sujets humains ont été évalués. Cinquante et un articles cliniques ont été inclus dans notre analyse, incluant des cas, tous assistés par robot, de pyéloplas-tie, de néphrectomie, de néphro-urétérectomie, de néphrectomie chez des donneurs vivants et de néphrectomie partielle. Pour chacune de ces interventions, la faisabilité a été démontrée. Des techniques assistées par robot ont été décrites pour pratiquement tous

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Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system

Cited by 217 publications

References 18 publications

Laparoscopic pyeloplasty: the first decade

Laparoscopic pyeloplasty: the first decade

Robot Assisted Laparoscopic Transmesocolic Right Pyeloplasty: Case Report

Robotic renal surgery: The future or a passing curiosity?

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