Robotic Pyeloplasty: The University of California-Irvine Experience

摘要

PURPOSE: For the treatment of ureteropelvic junction obstruction laparoscopic dismembered pyeloplasty and open pyeloplasty have similar outcomes. We present our experience with robot assisted laparoscopic dismembered pyeloplasty. MATERIALS AND METHODS: We retrospectively reviewed all adult robot assisted laparoscopic dismembered pyeloplasties performed at our institution between November 2002 and July 2009. Preoperative evaluation included abdominal computerized tomography angiogram to assess for crossing vessels and diuretic renal scan to quantify the degree of obstruction. Followup with diuretic renal scan and a patient pain analog scale was performed 3, 6 and 12 months after surgery. If the study was normal at 12 months, the patient was followed with ultrasound of the kidneys and bladder to look for ureteral jets. Absent ureteral jets, worsening hydronephrosis or patient complaint of pain necessitated repeat diuretic renogram. RESULTS: A total of 61 robot assisted laparoscopic dismembered pyeloplasties were performed in 21 men and 40 women. Followup was available for 57 patients with an average ± SD age of 35 ± 16 years and average followup of 18 ± 15 months. Mean operative time was 335 ± 88 minutes and estimated blood loss was 61 ± 48 ml. Average hospitalization time was 2 ± 0.9 days and the average postoperative analgesia requirement was 13 ± 9.6 mg morphine sulfate equivalents. The overall success rate was 81% based on a normal diuretic renogram and lack of pain using a validated pain scale. There were 3 grade III Clavien complications for a 4.9% major complication rate. CONCLUSIONS: Robot assisted laparoscopic dismembered pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. When measured by the more stringent application of diuretic renography and analog pain scales, the success rate for ureteropelvic junction obstruction management appears similar to that of open or standard laparoscopic approaches.