Robotic Anderson‐Hynes pyeloplasty: 5‐year experience of one centre

Abstract

OBJECTIVE To present our 5‐year experience with robotically assisted laparoscopic pyeloplasty (RALP), as LP has been shown to have similar success rates as open surgery, but standard LP requires high operative skills and a correspondingly long period of training, limiting its widespread availability, and RALP is easier and quicker to learn due to facilitated intracorporeal suturing. PATIENTS AND METHODS In all, 92 patients had transperitoneal RALP for pelvi‐ureteric junction obstruction (PUJO) using the daVinci system (Intuitive Surgical, Sunnyvale, CA, USA). A transperitoneal dismembered Anderson‐Hynes procedure was used in all cases. Three robotic ports and one assistant port were used in all cases while a JJ stent was left indwelling for 6 weeks. Both primary PUJO (including horseshoe kidneys in 80 cases) and secondary (in 12 cases) were considered eligible. The follow‐up included ultrasonography, excretory urography and renal scintigraphy. RESULTS The mean follow‐up was 39.1 months; PUJO was successfully resolved in 89 patients (96.7%) while three required additional procedures. Haemorrhage into the collecting system and urine extravasation occurring early after surgery were the causes of failure. The mean (range) operative duration, including the set‐up of the robot, was 108.34 (72–215) min; the mean duration of docking and surgery significantly decreased with experience (P < 0.001). The mean hospital stay was 4.57 days. Split renal function improved from 37.6% to 41.9%. No cases of secondary PUJO were recorded during extended follow‐up. CONCLUSIONS RALP using the daVinci system is safe and effective, achieving similar long‐term success rates to open surgery. The three‐dimensional versatility of the robot enables the surgeon to recapitulate the open procedure. The results were durable with no cases of late complications, corroborating the accuracy of robot‐assisted intracorporeal suturing and the subsequent quality of the pelvi‐ureteric anastomosis. Moreover, the robotic approach was easy and quick to learn for both the surgical and the technical staff. Therefore, RALP is our preferred technique to treat PUJO.

Outcome analysis of robotic pyeloplasty: a large single‐centre experience

“…In 2002, Gettman et al [17] reported the first human series of RALP with favourable results and less operative and suturing time. Schwentner et al [8] reported a largest single-centre experience of 92 patients with a follow-up of 39 months with 96.7% success rate with 80 primary repairs and 12 secondary repairs. Data favouring the robotic technique is now available from several other groups, confirming it to be safe, durable and effective [9,18].…”

“…However, LP is technically difficult and requires extensive training, experience and advanced laparoscopic skills for precise tissue dissection and intracorporeal suturing Robot-assisted LP (RALP) bypasses the shortcomings of the pure laparoscopic technique while maintaining its minimally invasive status by providing magnified threedimensional vision, improved dexterity and several degrees of movements of the instruments. It is gradually gaining in popularity, with excellent results being reported by several investigators [8,9]. We present a large single-centre experience of 85 consecutive cases (86 procedures) of RALP, with the follow-up, to share the perioperative and functional outcomes with this relatively new technique.…”

Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction

“…25 The steep learning curve for laparoscopic pyeloplasty may be smoothed by the adoption of robotic-assisted pyeloplasty, which appears to be as effective as open and laparoscopic approaches. [33][34][35][36] Other exciting developments, such as single-port pyeloplasty, are on the horizon. 37 In the meantime, laparoscopic pyeloplasty will remain the far superior treatment option for virtually all patients undergoing treatment of ureteropelvic junction obstruction.…”

Robotic renal surgery: The future or a passing curiosity?

“…The indications for RALP are the same as standard laparoscopic or open pyeloplasty. RALP has been performed safely and effectively in patients with primary UPJO or secondary UPJO after a failed previous repair, 28,31,33 as well as in both pelvic and horseshoe kidneys. 28,31,34 The robotic approach can also be used to successfully manage concomitant renal stones at the time of the surgery.…”

“…RALP has been performed safely and effectively in patients with primary UPJO or secondary UPJO after a failed previous repair, 28,31,33 as well as in both pelvic and horseshoe kidneys. 28,31,34 The robotic approach can also be used to successfully manage concomitant renal stones at the time of the surgery. 23,25,28,34 Contraindications to RALP are the same as standard laparoscopic pyeloplasty and include poor renal function, poor surgical candidate, uncorrected coagulopathy, abdominal wall infection and bowel obstruction.…”