Is Retroperitoneal Approach Feasible for Robotic Dismembered Pyeloplasty: Initial Experience and Long-Term Results

Abstract

OBJECTIVES: To present our initial series of robotic-assisted retroperitoneal dismembered pyeloplasty in adults patients using the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). METHODS: Ten adult patients with unilateral ureteropelvic junction (UPJ) obstruction underwent robotic-assisted retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty between February 2004 and March 2005. UPJ obstruction was primary in six patients and secondary in four patients after failed endopyelotomy. Dismembered pyeloplasty was performed utilizing a retroperitoneal approach (developed by balloon dissection). Three retroperitoneal laparoscopic ports were placed for the robot, and a fourth port was used by the assistant. Robotic-assisted laparoscopic technique was utilized to perform the entire procedure in all cases. RESULTS: All cases (seven right, three left) were successfully completed using the robot without conversion to conventional laparoscopic or open technique. Median surgical time was 175 minutes (95% confidence interval [CI] 128-185), median estimated blood loss was 50 mL (95% CI, 26-62), and the median hospital stay was 48 hours (95% CI, 27-65). No complications occurred. At a mean follow-up of 30 months (range 24-36), clinical symptomatic assessment with a numeric pain scale, health-related quality of life evaluation with the Short Form 36 health survey, and functional assessment with Tc-99m-mercaptoacetyltriglycine, diuretic renography, and intravenous urogram demonstrated a successful outcome in all cases. CONCLUSIONS: Robotic-assisted dismembered pyeloplasty can be performed efficiently by the retroperitoneal laparoscopic technique. Our surgical outcomes are comparable to previously published laparoscopic and transperitoneal robotic-assisted dismembered pyeloplasty series in adults with excellent clinical and radiologic success rates.