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• W1982367596 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2011Robotic Pyeloplasty: The University of California-Irvine Experience Mohamed Etafy, Donald Pick, Shary Said, Thomas Hsueh, David Kerbl, Phillip Mucksavage, Michael Louie, Elspeth McDougall, and Ralph Clayman Mohamed EtafyMohamed Etafy More articles by this author , Donald PickDonald Pick More articles by this author , Shary SaidShary Said More articles by this author , Thomas HsuehThomas Hsueh More articles by this author , David KerblDavid Kerbl More articles by this author , Phillip MucksavagePhillip Mucksavage More articles by this author , Michael LouieMichael Louie More articles by this author , Elspeth McDougallElspeth McDougall Financial interest and/or other relationship with Endocare, Simbionix, Intuitive Surgical, Ethicon Endo-Surgery, Karl Storz Endoscopy America and Omeros. More articles by this author , and Ralph ClaymanRalph Clayman Financial interest and/or other relationship with Cook Urological, Applied Urology, Intuitive Surgical, Omeros, Greenwald and Orthopedic Service. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.054AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: For the treatment of ureteropelvic junction obstruction laparoscopic dismembered pyeloplasty and open pyeloplasty have similar outcomes. We present our experience with robot assisted laparoscopic dismembered pyeloplasty. Materials and Methods: We retrospectively reviewed all adult robot assisted laparoscopic dismembered pyeloplasties performed at our institution between November 2002 and July 2009. Preoperative evaluation included abdominal computerized tomography angiogram to assess for crossing vessels and diuretic renal scan to quantify the degree of obstruction. Followup with diuretic renal scan and a patient pain analog scale was performed 3, 6 and 12 months after surgery. If the study was normal at 12 months, the patient was followed with ultrasound of the kidneys and bladder to look for ureteral jets. Absent ureteral jets, worsening hydronephrosis or patient complaint of pain necessitated repeat diuretic renogram. Results: A total of 61 robot assisted laparoscopic dismembered pyeloplasties were performed in 21 men and 40 women. Followup was available for 57 patients with an average ± SD age of 35 ± 16 years and average followup of 18 ± 15 months. Mean operative time was 335 ± 88 minutes and estimated blood loss was 61 ± 48 ml. Average hospitalization time was 2 ± 0.9 days and the average postoperative analgesia requirement was 13 ± 9.6 mg morphine sulfate equivalents. The overall success rate was 81% based on a normal diuretic renogram and lack of pain using a validated pain scale. There were 3 grade III Clavien complications for a 4.9% major complication rate. Conclusions: Robot assisted laparoscopic dismembered pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. When measured by the more stringent application of diuretic renography and analog pain scales, the success rate for ureteropelvic junction obstruction management appears similar to that of open or standard laparoscopic approaches. References 1 : Initial complications and late results in dismembered pyeloplasty. J Urol1977; 118: 162. Link, Google Scholar 2 : Ureteropelvic junction obstruction in adults. Urology1984; 23: 331. Google Scholar 3 : Laparoscopic pyeloplasty: the first 100 cases. J Urol2002; 167: 1253. Link, Google Scholar 4 : Management of adult ureteropelvic junction obstruction–is it time for a new gold standard?. J Urol2006; 176: 866. Link, Google Scholar 5 : Retrospective comparison of retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction. J Urol2006; 176: 1077. Link, Google Scholar 6 : Telemedicine and surgical robotics: urologic applications. Rev Urol1999; 1: 104. Google Scholar 7 : Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve?. Urology2002; 60: 39. Google Scholar 8 : Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol2008; 180: 1391. Link, Google Scholar 9 : Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology2003; 61: 699. Google Scholar 10 : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg2004; 240: 205. Google Scholar 11 : Long-term success of antegrade endopyelotomy compared with pyeloplasty at a single institution. J Endourol2006; 20: 707. Google Scholar 12 : Robotic-assisted laparoscopic pyeloplasty: a pilot study. Urology1999; 53: 1099. Google Scholar 13 : Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology2002; 60: 509. Google Scholar 14 : Da Vinci robot assisted Anderson-Hynes dismembered pyeloplasty: technique and 1 year follow-up. World J Urol2003; 21: 133. Google Scholar 15 : Robotic computer-assisted pyeloplasty versus conventional laparoscopic pyeloplasty. J Endourol2006; 20: 813. Google Scholar 16 : Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol2003; 170: 1738. Link, Google Scholar 17 : Role of robotics in the management of secondary ureteropelvic junction obstruction. Int J Clin Pract2006; 60: 9. Google Scholar Department of Urology, University of California-Irvine, Irvine, California© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byStamm A, Akapame S, Durfy S and Kozlowski P (2019) Robotic Pyeloplasty in Patients with Equivocal Diuretic RenogramUrology Practice, VOL. 6, NO. 6, (364-368), Online publication date: 1-Nov-2019.Hsi R, Holt S, Gore J and Harper J (2018) Trends in Followup Imaging after Adult PyeloplastyJournal of Urology, VOL. 191, NO. 5, (1357-1362), Online publication date: 1-May-2014.Sukumar S, Sun M, Karakiewicz P, Friedman A, Chun F, Sammon J, Ghani K, Ravi P, Bianchi M, Jeong W, Shariat S, Hansen J, Peabody J, Elder J, Menon M and Trinh Q (2018) National Trends and Disparities in the Use of Minimally Invasive Adult PyeloplastyJournal of Urology, VOL. 188, NO. 3, (913-918), Online publication date: 1-Sep-2012. Volume 185Issue 6June 2011Page: 2196-2200 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordslaparoscopyroboticsureteral obstructionkidneyreconstructive surgical proceduresMetricsAuthor Information Mohamed Etafy More articles by this author Donald Pick More articles by this author Shary Said More articles by this author Thomas Hsueh More articles by this author David Kerbl More articles by this author Phillip Mucksavage More articles by this author Michael Louie More articles by this author Elspeth McDougall Financial interest and/or other relationship with Endocare, Simbionix, Intuitive Surgical, Ethicon Endo-Surgery, Karl Storz Endoscopy America and Omeros. More articles by this author Ralph Clayman Financial interest and/or other relationship with Cook Urological, Applied Urology, Intuitive Surgical, Omeros, Greenwald and Orthopedic Service. 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