Abstract:Objective: To summy the experience of robot-assisted laparoscopic pyeloplasty (RALP) for treatment of ureteropelvic junction obstruction (UPJO) and to exert the advantage of robot-assisted laparoscopic technology. Methods: We analyzed the clinical data and surgical methods of 21 cases of UPJO with RALP in our hospital from Sep. 2014 to Sep. 2016 retrospectively. There were 12 males and 9 females with a mean age of 26 years old (range: 17 to 37 years old). The lesions were located on the left side in 11 cases, on the right side in 9 cases and on the bilateral side in 1 case. Eighteen cases were diagnosed as UPJO on the one side, and 1 case on the bilateral side. There was 1 case of lower kidney UPJO with right renal duplication, and 1 case of left UPJO with renal calculus. All of cases underwent RALP. The surgical mothed of Anderson-Hynes was adopted. Results: Twenty-one RALP operations were finished succussfully and one of them underwent operation with bilateral sides. None was converted to open operation or traditional laparoscopy. The mean operative time of RALP was 85 min (from 65 to 110 min) and mean haemorrhage was 18 mL (from 10 to 30 mL). No leakage of urine after the operation occurred. The double J tubes were removed by cystoscope after 1 or 2 months. All the cases were followed up from 2 to 24 months. Hydronephrosis of 21 cases was mitigated. Conclusions: RALP could reduce difficulty and improve accuracy of laparoscopic pyeloplasty. The efficacy of surgery was satisfied.
[1]Poulakis V, Witzsch U, Schultheiss D, et al. History of ureteropelvic junction obstruction repair (pyeloplasty). From Trendelenburg (1886) to the present. Urologe A, 2004,43(12):1544-1559. [2]Foley FE. A new plastic operation for stricture at the uretero-pelvic junction. Report of 20 operations. 1937. J Urol, 2002,167(2 Pt 2):1075-1096. [3]Khan F, Ahmed K, Lee N, et al. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol, 2014,11(11):629-638. [4]Gill IS, Desai MM, Kaouk JH, et al. Percutaneous endopyeloplasty: description of new technique. J Urol, 2002,168(5):2097-2102. [5]Desai MM, Desai MR, Gill IS. Endopyeloplasty versus endopyelotomy versus laparoscopic pyeloplasty for primary ureteropelvic junctionobstruction. Urology, 2004,64(1):16-21. [6]李星智,韩胜利,谭朝晖,等.后腹腔镜下肾盂输尿管成型术10例初步报告.微创泌尿外科杂志,2015,4(6):337-340. [7]Umari P, Lissiani A, Trombetta C, et al. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery: report of 49 cases. Arch Ital Urol Androl, 2011,83(4):169-174. [8]Seo IY, Oh TH, Lee JW, et al. Long-term follow-up results of laparoscopic pyeloplasty. Korean J Urol, 2014,55(10):656-659. [9]周骏,梁朝朝,叶元平,等.3D腹腔镜技术在上尿路重建手术中应用的初步探讨.临床泌尿外科杂志,2014,29(6):471-473. [10]Tasian GE, Casale P. The robotic-assisted laparoscopic pyeloplasty: gateway to advanced reconstruction. Urol Clin North Am, 2015,42(1):89-97. [11]Pahwa M, Pahwa AR, Girotra M, et al. Defining the pros and cons of open, conventional laparoscopy, and robot-assisted pyeloplasty in a developing nation. Adv Urol, 2014,2014:850156. [12]Autorino R, Eden C, El-Ghoneimi A, et al. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol, 2014,65(2):430-452. [13]Hopf HL, Bahler CD, Sundaram CP, et al. Long-term outcomes of robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction. Urology, 2016,90:106-110. [14]Avery DI, Herbst KW, Lendvay TS, et al. Robot-assisted laparoscopic pyeloplasty: Multi-institutional experience in infants. J Pediatr Urol, 2015,11(3):139.e1-5. [15]Lindgren BW, Hagerty J, Meyer T, et al. Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective treatment option. J Urol, 2012,188(3):932-937. [16]Buffi NM, Lughezzani G, Fossati N, et al. Robot-assisted, single-site, dismembered pyeloplasty for ureteropelvic junction obstruction with the new da Vinci platform: a stage 2a study. Eur Urol, 2015,67(1):151-156.