Laparoscopic robotic‐assisted management of pelvi‐ureteric junction obstruction in patients with horseshoe kidneys: technique and 1‐year follow‐up

Abstract

Authors from France describe their experience, in a small series of patients with pelvi‐ureteric junction obstruction, of laparoscopic robotic‐assisted pyeloplasty, and present their operative results with a 1‐year follow‐up. The accuracy of MRI renal angiography and venography in predicting vascular anatomy before donor nephrectomy is presented by authors from the UK. They present evidence suggesting that this technique has the advantage over CT of having virtually no side‐effects, and felt it was a good investigation. OBJECTIVE To report our experience with laparoscopic robotic‐assisted management of pelvi‐ureteric junction obstruction (PUJO) in patients with horseshoe kidneys. PATIENTS AND METHODS Between January 2002 and May 2003, two men and a woman with horseshoe kidneys (mean age 44.6 years) had laparoscopic dismembered pyeloplasty with robotic assistance for PUJO with no division of the isthmus. Two patients had renal stones which were extracted during surgery. None of the patients had had previous abdominal surgery. RESULTS The mean operative duration was 148.3 min, the mean estimated blood loss was <100 mL and the mean hospital stay was 7.6 days. Renal function was preserved in all three patients during the immediate and long‐term follow‐up as measured by intravenous urography. The three patients had durable clinical and radiographic success during a mean follow‐up of 21 months. One patient needed complementary extracorporeal shockwave lithotripsy, and one had an episode of pyelonephritis, which was treated successfully. There were no other significant complications before or after surgery. CONCLUSION Laparoscopic robotic‐assisted pyeloplasty for horseshoe kidney is safe and feasible, offering the advantages of minimally invasive surgical procedures with enhanced laparoscopic skills related to the use of the robot.

Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

“…All 3 patients had resolution on clinical and radiographic evaluation up to 21 months (Table 3). 11 Crossing renal vessels are present in at least 40% of adults with primary UPJO. 1 Highly variable anomalous blood supply to horseshoe kidneys further increases the potential for extrinsic compression of an entrapped ureter.…”

Robotic Laparoscopic Pyeloplasty

“…Our group pioneered the use of the laparoscopic robotic approach in these challenging anatomic cases, 18 describing a portion of the data that are presented in the current report. A similar technique was later reported by Pe et al 22 in a case report of a previously treated UPJO in a patient with a horseshoe kidney, also performed with the robotic technique.…”

“…11,14 have gained popularity, and a number of studies evaluating robotic pyeloplasty are currently available indicating favorable outcomes [15][16][17] even in the presence of challenging anatomic findings. 18 There are only a few studies showing the feasibility and outcomes of the robotic technique in a challenging scenario, including previously managed UPJO patients 19 -22 or patients with anatomic anomalies. 8,18,20,22 Therefore we evaluated our experience using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, California) as an alternative for surgically managing UPJO in patients with either anatomic abnormalities or a recurrent obstruction after a previous procedure.…”

Vascular Renal Anatomy and the Ureteropelvic Junction: Preoperative Multidetector CT Scanning with Split-Bolus Injection as a Predictor of Laparoscopic Findings

“…In our experience with nearly 100 cases, the success rate is high, even in complex situations such horseshoe kidneys. 10 …”