Pyeloplasty

What Is a Pyeloplasty?

A pyeloplasty is an operation to repair the junction of the ureter (the tube that connects the kidney to the bladder) and the kidney (called Uretero-pelvic junction i.e. UPJ). When this tube is narrowed it does not allow the kidney to function properly by affecting its ability to drain. Over time this will damage the kidney.

What Is Robot-Assisted Surgery?

Robot-assisted surgery is a technique that uses a robotic console (the daVinci^® system) to help the surgeon during the operation. It is important to understand that the robot is not performing the surgery. The surgeon still carries out the procedure, but the robotic console allows more controlled and precise movements during the operation. Robotic camera goes through your abdomen via small keyhole and two to three keyhole incisions in your abdomen are used for operating instruments.

What Is The Advantage Of Robotic Pyeloplasty As Compared To Open Surgery?

Robotic surgery for treating symptomatic UPJ obstruction has significant benefits to the patient, including reduced blood loss and transfusions, reduced pain, shorter hospital stays, smaller scars, improved cosmesis, and a faster recovery as compared to open surgery. You are generally able to start eating and drinking more quickly, enabling you to return to your normal activities sooner than with traditional open surgery. As such, it has become the standard of care for the surgical management of UPJ obstruction. The success of robotic pyeloplasty is similar to open pyeloplasty in terms of resolution of obstruction and symptoms.

Why Use The Robot For This Surgery?

The robotic wrists of the da Vinci robot give the surgeon a freedom and dexterity of motion that cannot be achieved by simple laparoscopic instruments alone. This results in more efficient suturing and dissecting during the surgical repair of your UPJ obstruction.

Are There Potential Disadvantages Of The Robotic Approach Compared To Open?

In general there are no particular disadvantages. However, some situations may dictate the need for open surgery (see below).

What Are The Risks?

As with any surgery, there are some risks.

• Damage to structures inside your abdomen, bowel, liver, spleen, or blood vessels. and other organs from the instruments. [ 2-4%]
• Risk of developing a port site hernia (<5%)
• Shoulder pain immediately after surgery which resolves on its own (5-10%)
• Bleeding requiring blood transfusion (1-2%)
• Urinary leak requiring a prolonged hospital stay (3-5%)
• Complications associated with general anesthetic, such as irregular heartbeat, chest infection, or blood clots in the legs (deep vein thrombosis or DVT) or lungs (pulmonary embolism).

During the surgery, a tube going from kidney to bladder called Double J Stent would be placed which will not be visible externally. Due to stent, you might have some burning micturition, dull-aching pain in the loin or urinary urgency. This stent is removed 4-6 weeks after surgery via endoscopy (cystoscopy) under local anaesthesia.

What Patients Are Not Good Candidates For Robotic Pyeloplasty?

Patients with a prior history of multiple and extensive abdominal surgery esp. kidney surgery may have excessive scarring around the kidney and renal pelvis, and therefore may not be ideal candidates for a robotic approach. In such cases an open approach may be required. Patients with medical conditions such as severe lung and heart disease may not be able to tolerate a robotic  approach due to the need for a general anesthetic.

 What Happens If Complications Arise And Conversion To Open Surgery Is Required

Although extremely rare, conversion to open surgery may be required if difficulty with dissection is encountered during the robotic approach. Our surgeons are trained in open surgical approaches as well as robotic/laparoscopic surgery and therefore are well equipped to complete the surgery in an open fashion if needed.

What Is The Overall Success Rate Of Robotic Pyeloplasty?

Success rate in terms of complete radiographic resolution of the obstruction is approximately 90% with symptomatic relief in approximately 95%. In comparison, endoscopic techniques such as endopyelotomy are associated with a 70% success rate. Balloon dilation of a UPJ obstruction is rarely a long term solution for this condition.

Will Future X-Ray Tests Be Required After Surgery ?

Follow up imaging studies such as nuclear renal scan, nitravenous pyelogram, or ct  scan are often obtained to confirm drainage of the affected kidney and to document success of the repair. Your surgeon will determine the appropriate timing and preference of imaging studies.