Abstract
Minimally invasive dismembered pyeloplasty has become the gold-standard treatment for symptomatic pelvi–ureteric junction obstruction (PUJO) in recent years. A small proportion of patients with PUJO have horseshoe kidneys. We present two cases of robot-assisted pyeloplasty in horseshoe kidneys and describe the technical modifications for success in these cases. Two patients, aged 28 and 35 years, were diagnosed with symptomatic PUJO in horseshoe kidneys. Both had a robotic-assisted laparoscopic dismembered pyeloplasty using the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Three-dimensional computed tomography (CT) reconstructions were performed pre-operatively to plan surgery. The transperitoneal ports were placed more caudally than usual for improved access to the PUJ. The isthmus was not divided in either case. The procedures took 190 and 90 min, respectively, with minimal blood loss and no post-operative complications. Patients were discharged on post-operative day 2 following catheter and drain removal. Follow-up diuretic renograms showed no residual obstruction and patients were symptomatically better. Our initial experience suggests that RALP is a safe and feasible option for the treatment of PUJO in horseshoe kidneys with good short-term outcomes. These are challenging cases and robust pre-operative planning combined with technical modifications has been beneficial to our success. The enhanced suturing possible with the da Vinci® surgical system facilitates these procedures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Yohannes P, Smith AD (2002) The endourological management of complications associated with horseshoe kidney. J Urol 168(1):5–8
O’ Reilly PH, Brooman PJ, Mak S et al (2001) The long-term results of Anderson–Hynes pyeloplasty. BJU Int 87(4):287–289
Moon DA, El-Shazly MA, Chang CM et al (2006) Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 67(5):932–936
Jarrett TW, Chan DY, Charambura TC et al (2002) Laparoscopic pyeloplasty: the first 100 cases. J Urol 167(3):1253–1256
Murphy D, Challacombe B, Elhage O et al (2008) Robotically assisted laparoscopic pyeloplasty. BJU Int 102:136–151
Patel V (2005) Robotic-assisted laparoscopic dismembered pyeloplasty. Urology 66(1):45–48
Thiel DD, Winfield HN (2007) Robotic assisted laparoscopic pyeloplasty. Minerva Urol Nefrol 59(2):167–177
Link R, Bhayani S, Kavoussi L (2006) A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 243(4):486–491
Bove P, Ong A, Rha K et al (2004) Laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract anomalies. J Urol 172(2):77–79
Shah KK, Louie M, Thaly RK et al (2007) Robotic assisted laparoscopic pyeloplasty: a review of current status. Int J Med Robot 3:35–40
Mufarrij PW, Woods M, Shah OD et al (2008) Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol 180(4):1391–1396
Schwentner C, Pelzer A, Neururer R et al (2007) Robotic Anderson–Hynes pyeloplasty: 5 year experience of one centre. BJU Int 100(4):880–885
Chammas M, Feuillu B, Coissard A et al (2006) Laparoscopic robotic-assisted management of pelvi–ureteric junction obstruction in patients with horseshoe kidneys: technique and 1-year follow-up. BJU Int 97(3):579–583
Acknowledgments
Guy’s & St Thomas’s Charitable Foundation, British Urological Foundation.
Conflicts of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spencer, CD., Sairam, K., Challacombe, B. et al. Robot-assisted laparoscopic pyeloplasty for the management of pelvi–ureteric junction obstruction in horseshoe kidneys: initial experience. J Robotic Surg 3, 99–102 (2009). https://doi.org/10.1007/s11701-009-0142-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-009-0142-x