title: Robot-assisted laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: a multi-institutional experience.
abstract: OBJECTIVE
  To report a 6-year multi-institutional experience and outcomes with robot-assisted laparoscopic pyeloplasty (RLP) for the repair of ureteropelvic junction obstruction (UPJO).
  
  
  METHODS
  Between June 2002 and October 2008, 168 adult patients from 3 institutions underwent RLP for UPJO. A retrospective analysis of prospectively collected data were performed after institutional review board approval. Diagnosis was by intravenous urogram or computed tomography scan and diuretic renogram. All patients underwent RLP through a 4-port laparoscopic technique. Demographic, preoperative, operative, and postoperative endpoints for primary and secondary repair of UPJO were measured. Success was defined as a T½ of <20 minutes on diuretic renogram and symptom resolution. Pain resolution was assessed by subjective patient reports.
  
  
  RESULTS
  Of 168 patients, 147 (87.5%) had primary repairs and 21 (12.5%) had secondary repairs. Of the secondary repairs, 57% had a crossing vessel etiology. Mean operative time was 134.9 minutes, estimated blood loss was 49 mL, and length of stay was 1.5 days. Mean follow-up was 39 months. Overall, 97.6% of patients had a successful outcome, with a 6.6% overall complication rate.
  
  
  CONCLUSIONS
  To our knowledge, this review represents the largest multi-institutional experience of RLP with intermediate-term follow-up. RLP is a safe, efficacious, and viable option for either primary or secondary repair of UPJO with reproducible outcomes, a high success rate, and a low incidence of complications.
authors.affiliation: Global Robotics Institute, Florida Hospital Celebration Health, and University of Central Florida, Celebration, FL 34747, USA.
authors.forename: Ananthakrishnan
authors.initials: A
authors.lastname: Sivaraman
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Leveillee
authors.forename: Manoj B
authors.initials: MB
authors.lastname: Patel
authors.forename: Sanket
authors.initials: S
authors.lastname: Chauhan
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Bracho
authors.forename: Charles R
authors.initials: CR
authors.lastname: Moore
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Coelho
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Palmer
authors.forename: Oscar
authors.initials: O
authors.lastname: Schatloff
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bird
authors.forename: Ravi
authors.initials: R
authors.lastname: Munver
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012371:Robotics; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult