title: Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery.
abstract: OBJECTIVE
  To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy.
  
  
  METHODS
  From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments.
  
  
  RESULTS
  The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4-22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal.
  
  
  CONCLUSIONS
  Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure.
authors.affiliation: Department of Urology, Center for Minimally Invasive Urologic Surgery, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
authors.forename: Fatih
authors.initials: F
authors.lastname: Atug
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
authors.forename: Scott V
authors.initials: SV
authors.lastname: Burgess
authors.forename: Raju
authors.initials: R
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012371:Robotics; D014517:Ureteral Obstruction / Q000601:surgery*