title: Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience.
abstract: OBJECTIVE
  The introduction of the da Vinci Surgical System to perform complex reconstructive procedures, such as repair of ureteropelvic junction obstruction, has helped to overcome some of the technical challenges associated with laparoscopy. We review our large multi-institutional experience with long-term followup of robotic dismembered pyeloplasty.
  
  
  METHODS
  A total of 140 patients from 3 university medical centers underwent robotic dismembered pyeloplasty. An institutional review board approved retrospective chart review was performed to collect demographic, preoperative, operative and postoperative data. Patients were analyzed as an entire cohort and then divided into various subgroups.
  
  
  RESULTS
  Of the cases 117 (84.6%) were primary repairs and 23 (16.4%) were secondary repairs. There were 13 (9.3%) patients who underwent concomitant stone extraction and 5 (3.6%) procedures were performed on patients with solitary kidneys. A crossing vessel was found in 77 (55%) patients. Mean operative time was 217 minutes (range 80 to 510), estimated blood loss was 59.4 ml (range 10 to 600), mean length of hospital stay 2.1 days (range 0.75 to 7) and mean followup was 29 months (range 3 to 63). Radiographic resolution of obstruction on first postoperative diuretic renal scan or excretory urogram was noted in 134 patients (95.7%). There was a 7.1% major complication rate and a 2.9% minor complication rate. No statistically significant differences were found in any parameters among patients from the various cohorts.
  
  
  CONCLUSIONS
  To our knowledge this review represents the largest multi-institutional experience of robotic dismembered pyeloplasty with long-term followup. Robotic pyeloplasty appears to be safe, durable and efficacious for primary and secondary ureteropelvic junction obstruction with or without concomitant stone extraction, and for patients with a solitary kidney.
authors: Department of Urology, New York University Medical Center and Mount Sinai Medical Center, New York 10016, USA. mufarp01@med.nyu.edu
authors: Patrick W
authors: PW
authors: Mufarrij
authors: Michael
authors: M
authors: Woods
authors: Ojas D
authors: OD
authors: Shah
authors: Michael A
authors: MA
authors: Palese
authors: Aaron D
authors: AD
authors: Berger
authors: Raju
authors: R
authors: Thomas
authors: Michael D
authors: MD
authors: Stifelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015337:Multicenter Studies as Topic; D010149:Postoperative Pain; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography