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Robot-assisted laparoscopic pyeloplasty with stone removal in an ectopic pelvic kidney.

Nayyar R, Singh P, Gupta NP - JSLS (2010 Jan-Mar)

Bottom Line: A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time.The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes.Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Ectopic pelvic kidneys with ureteropelvic junction obstruction and stones present a treatment challenge for the minimally invasive surgeon. A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time. The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes. Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.

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Related in: MedlinePlus

Port position for robotic pyeloplasty with pyelolithotomy in a pelvic kidney with ureteropelvic junction obstruction and a secondary stone.
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Figure 2: Port position for robotic pyeloplasty with pyelolithotomy in a pelvic kidney with ureteropelvic junction obstruction and a secondary stone.

Mentions: Left retrograde pyelography (RGP) demonstrated a normal ureter with narrowing at UPJ, gross hydronephrosis, and a secondary calculus in the renal pelvis. Retrograde insertion of the JJ stent was not possible during RGP. Overall, 5 ports were placed including 3 robotic ports as shown in Figure 2. Patient positioning was changed to a steep Trendelenburg, and the robot was docked. The hydronephrotic renal pelvis was dissected, and a longitudinal incision was made over it. A JJ stent was placed in an antegrade fashion, and Fenger's pyeloplasty was performed using 4′0 polyglactin suture. A stone was retrieved in a homemade pouch through the 12-mm port site. The overall operating room time was 94 minutes, while the surgeon's console time was 56 minutes. Postoperative recovery was uneventful, and the drain was removed on the second postoperative day. The patient was discharged on the third day, and the stent was kept for 4 weeks. At 6-month follow-up, the patient had serum creatinine of 1.9mg% and is symptom free with a left-sided split renal function of 24% and normal clearance on both sides.


Robot-assisted laparoscopic pyeloplasty with stone removal in an ectopic pelvic kidney.

Nayyar R, Singh P, Gupta NP - JSLS (2010 Jan-Mar)

Port position for robotic pyeloplasty with pyelolithotomy in a pelvic kidney with ureteropelvic junction obstruction and a secondary stone.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021313&req=5

Figure 2: Port position for robotic pyeloplasty with pyelolithotomy in a pelvic kidney with ureteropelvic junction obstruction and a secondary stone.
Mentions: Left retrograde pyelography (RGP) demonstrated a normal ureter with narrowing at UPJ, gross hydronephrosis, and a secondary calculus in the renal pelvis. Retrograde insertion of the JJ stent was not possible during RGP. Overall, 5 ports were placed including 3 robotic ports as shown in Figure 2. Patient positioning was changed to a steep Trendelenburg, and the robot was docked. The hydronephrotic renal pelvis was dissected, and a longitudinal incision was made over it. A JJ stent was placed in an antegrade fashion, and Fenger's pyeloplasty was performed using 4′0 polyglactin suture. A stone was retrieved in a homemade pouch through the 12-mm port site. The overall operating room time was 94 minutes, while the surgeon's console time was 56 minutes. Postoperative recovery was uneventful, and the drain was removed on the second postoperative day. The patient was discharged on the third day, and the stent was kept for 4 weeks. At 6-month follow-up, the patient had serum creatinine of 1.9mg% and is symptom free with a left-sided split renal function of 24% and normal clearance on both sides.

Bottom Line: A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time.The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes.Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Ectopic pelvic kidneys with ureteropelvic junction obstruction and stones present a treatment challenge for the minimally invasive surgeon. A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time. The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes. Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.

Show MeSH
Related in: MedlinePlus