title: Feasibility and preliminary clinical outcomes of robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-port platform.
abstract: This study tested the technical feasibility and short-term perioperative outcomes of the novel da Vinci Single-Site Instrumentation platform for the treatment of upper ureteropelvic junction obstruction (UPJO) in a selected group of patients. Nine patients underwent robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-site platform for UPJO at our department of urology. All the procedures were completed without the need for traditional robotic surgery or laparoscopic/open conversion, although in one patient with congenital hepatomegaly it was necessary to use an auxiliary 3-mm trocar to retract the liver properly and expose the surgical field. Mean operative time was 166 min, and no intraoperative complications were recorded. The indwelling catheter was removed on postoperative day 2 in five patients and on postoperative day 3 in four patients. Patients were discharged the day after drain removal. One patient experienced transient hyperpyrexia, treated with antibiotics. No other complications were observed. All patients had the DJ stent removed 4 wk after surgery, following a negative urine culture and abdominal ultrasound evaluation. The five patients who reached a 3-mo follow-up had a clinical resolution of preoperative symptoms and hydronephrosis at the abdominal ultrasound. The same results were maintained in the two patients with 6-mo follow-up evaluations. In selected patients, R-LESS pyeloplasty using the new single-port platform appears to be a technically feasible and reproducible surgical procedure for the minimally invasive treatment of UPJO. Prolonged follow-up and larger series are required to confirm its potential role as a valid alternative to standard robotic pyeloplasty.
authors.affiliation: Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy. a_cestari@yahoo.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Cestari
authors.forename: Nicolò Maria
authors.initials: NM
authors.lastname: Buffi
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lista
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.forename: Mattia
authors.initials: M
authors.lastname: Sangalli
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult