Robot-assisted laparoscopic dismembered pyeloplasty.
OBJECTIVE
Advanced laparoscopic skills limit the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the da Vinci Robotic Surgical System at 3 New York City medical centers.


METHODS
A review of all robot-assisted laparoscopic Anderson-Hynes dismembered pyeloplasty cases in 38 patients (21 females, 17 males) between April 2001 and January 2004 was performed. All patients had symptoms or radiographic evidence of ureteropelvic junction obstruction. Robotic assistance with the da Vinci Robotic Surgical System was used after preparation of the ureteropelvic junction with a standard laparoscopic approach.


RESULTS
The average patient age was 39.3 years (range, 15 to 69). The mean operative time and suturing time were 225.6+/-59.3 minutes and 64.2+/-14.6 minutes. The average estimated blood loss was minimal at 77.3+/-55.3 mL. The mean length of hospitalization was 69.6 hours (range, 28 to 310). The average use of intravenous morphine was 26.5 mg (range, 0 to 162). No intraoperative complications occurred, and open conversions were not necessary. A mean follow-up of 12.2 months revealed a success rate of 94.7% with 2/38 patients requiring further treatments.


CONCLUSIONS
This combined multi-institutional series reveals that robot-assisted pyeloplasty with the da Vinci Surgical System is safe and reproducible. These intermediate results appear comparable to results with open and laparoscopic pyeloplasty repairs.
Palese
Michael A
MA
The Mount Sinai School of Medicine, Department of Urology, New York, New York, USA. Michael.Palese@MountSinai.org
Munver
Ravi
R
Phillips
Courtney K
CK
Dinlenc
Caner
C
Stifelman
Michael
M
DelPizzo
Joseph J
JJ
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012371:Robotics / Q000295:instrumentation; D013997:Time Factors; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods