Robot-assisted Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: A Multi-institutional Experience

Objective To report a 6-year multi-institutional experience and outcomes with robot-assisted laparoscopic pyeloplasty (RLP) for the repair of ureteropelvic junction obstruction (UPJO). Patients and Methods Between June 2002 and October 2008, 168 adult patients from 3 institutions underwent RLP for U...

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Published in:	Urology (Ridgewood, N.J.) Vol. 79; no. 2; pp. 351 - 355
Main Authors:	Sivaraman, Ananthakrishnan, Leveillee, Raymond J, Patel, Manoj B, Chauhan, Sanket, Bracho, Jorge E, Moore, Charles R, Coelho, Rafael F, Palmer, Kenneth J, Schatloff, Oscar, Bird, Vincent G, Munver, Ravi, Patel, Vipul R
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-02-2012 Elsevier
Subjects:	Adult Aged Biological and medical sciences Blood Loss, Surgical - statistics & numerical data Female Humans Kidney Pelvis - surgery Kidneys Laparoscopy - methods Length of Stay - statistics & numerical data Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Postoperative Care Postoperative Complications - epidemiology Reoperation - statistics & numerical data Retrospective Studies Robotics Stents Treatment Outcome Ureter - surgery Ureteral Obstruction - surgery Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland Urology Young Adult Kidney disease Endoscopic surgery Nephrology Urinary system disease Ureteral disease Laparoscopic surgery Urinary tract disease Pyeloplasty Robotics Urology Hydronephrosis Treatment Pyeloureteral junction obstruction
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Summary:	Objective To report a 6-year multi-institutional experience and outcomes with robot-assisted laparoscopic pyeloplasty (RLP) for the repair of ureteropelvic junction obstruction (UPJO). Patients and Methods Between June 2002 and October 2008, 168 adult patients from 3 institutions underwent RLP for UPJO. A retrospective analysis of prospectively collected data were performed after institutional review board approval. Diagnosis was by intravenous urogram or computed tomography scan and diuretic renogram. All patients underwent RLP through a 4-port laparoscopic technique. Demographic, preoperative, operative, and postoperative endpoints for primary and secondary repair of UPJO were measured. Success was defined as a T½ of <20 minutes on diuretic renogram and symptom resolution. Pain resolution was assessed by subjective patient reports. Results Of 168 patients, 147 (87.5%) had primary repairs and 21 (12.5%) had secondary repairs. Of the secondary repairs, 57% had a crossing vessel etiology. Mean operative time was 134.9 minutes, estimated blood loss was 49 mL, and length of stay was 1.5 days. Mean follow-up was 39 months. Overall, 97.6% of patients had a successful outcome, with a 6.6% overall complication rate. Conclusions To our knowledge, this review represents the largest multi-institutional experience of RLP with intermediate-term follow-up. RLP is a safe, efficacious, and viable option for either primary or secondary repair of UPJO with reproducible outcomes, a high success rate, and a low incidence of complications.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-4295 1527-9995
DOI:	10.1016/j.urology.2011.10.019