Transmesocolic robot-assisted pyeloplasty: single center experience.
OBJECTIVE
To demonstrate the technical feasibility of the transmesocolic approach of robotic pyeloplasty for left ureteropelvic junction obstruction (UPJO).


METHODS
Between July 2006 and December 2007, 60 patients underwent robot-assisted pyeloplasty that included 33 cases on the right side and 27 cases on the left side. Of the 27 left-side cases, 24 were performed using a transmesocolic approach. Three left-side surgeries were performed by mobilizing the colon because of associated accessory vessel and renal calculi. A pure robot-assisted dismembered reduction pyeloplasty with excision of the ureteropelvic junction was performed in all cases.


RESULTS
The mean operative time was 125.33 minutes. The time to perform the anastomosis was 43.58 minutes, and mean blood loss 38.7 mL. Average hospital stay was 2.5 days, and the drain was removed within 48 hours. One patient had prolonged drainage with fever because of a misplaced ureteral stent. Of the 24 patients, 23 were followed for 1 year and 1 was lost to follow-up. No patient demonstrated clinical or radiographic evidence of repeated obstruction.


CONCLUSIONS
In the transmesocolic approach, mobilization of the colon is not necessary, and the UPJO can be approached directly after incising the mesocolon. This approach is safe and feasible in patients with a thin mesentry and when extensive mobilization of the kidney is not needed for any associated problems. The technique is highly effective with durable success rates similar to those of open surgery.
Gupta
Narmada P
NP
Department of Urology, All India Institute of Medical Sciences, New Delhi, India. narmadagupta@gmail.com
Mukherjee
Satyadip
S
Nayyar
Rishi
R
Hemal
Ashok Kumar
AK
Kumar
Rajeev
R
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods*; D014567:Urography