title: Concurrent management of bilateral ureteropelvic junction obstruction in children using robotic-assisted laparoscopic surgery.
abstract: BACKGROUND
  Bilateral ureteropelvic junction (UPJ) obstruction occurs infrequently. When surgical management is deemed necessary, staged pyeloplasties traditionally have been recommended to minimize the morbidity associated with performing procedures concurrently. With the advent of robotic-assistance, concurrent surgical management can more readily be performed laparoscopically. In this report, we evaluated the safety and outcome of managing patients with bilateral UPJ obstruction with concurrent robotic-assisted laparoscopic pyeloplasty.
  
  
  METHODS
  We performed a retrospective review of five patients with bilateral ureteropelvic junction obstruction who underwent concurrent bilateral robotic-assisted pyeloplasties at our institution between October 2003 and April 2007. Technical consideration for patient positioning, robotic set-up, port placement, and the use of a hitch stitches was assessed. The operative time, complications, analgesic needs, length of hospitalization, and overall success of the procedure were evaluated.
  
  
  RESULTS
  Operative time ranged from 235 to 541 minutes (mean = 384). Estimated blood loss was 5-100 cc (mean = 48.0). Length of hospitalization ranged from 1.3 to 3.6 days (mean = 2.4). Ureteral stents were removed 3-8 weeks postoperatively. There were no complications. All kidneys demonstrated decreased hydronephrosis on postoperative ultrasound or improved drainage parameters on diuretic renography or IVP.
  
  
  CONCLUSIONS
  Simultaneous bilateral robotic-assisted laparoscopic pyeloplasties utilizing 4-port access is feasible and safe. It provides an effective method of managing patients with bilateral UPJ obstruction, avoiding the burden and morbidity of performing staged surgeries.
authors.affiliation: Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Freilich
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
authors.forename: Joseph
authors.initials: J
authors.lastname: Borer
authors.forename: Caleb
authors.initials: C
authors.lastname: Nelson
authors.forename: Carlo C
authors.initials: CC
authors.lastname: Passerotti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*