Retroperitoneal Robotic-Assisted Laparoscopic Pyeloplasty: A 10 Year Experience in a Single Institution

被引:3
作者
Whiting, Danielle [1 ]
Whitehurst, Lily [1 ]
Tsang, Derrick [1 ]
Hussain, Muddassar [1 ]
Malki, Manar [1 ]
Barber, Neil [1 ,2 ]
机构
[1] Frimley Pk Hosp, Dept Urol, Frimley, England
[2] Frimley Pk Hosp, Dept Urol, Portsmouth Rd, Frimley GU167UJ, England
关键词
robotic; retroperitoneal; ureteral obstruction; DISMEMBERED PYELOPLASTY; TRANSPERITONEAL;
D O I
10.1089/end.2021.0551
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Pelvi-ureteric junction (PUJ) obstruction was traditionally treated with open pyeloplasty. In recent decades, the development of minimally invasive techniques, including laparoscopic and later robotic surgery, has transformed treatment. The transperitoneal approach has most commonly been undertaken, with a few institutions reporting outcomes of the retroperitoneal approach. We report our 10-year experience of retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP).Methods: A prospective database of 160 patients undergoing RALP between February 2010 and November 2019 was analyzed. Data were recorded on demographics, operative details, complications, and success rate. Success was determined as symptomatic improvement and/or an unobstructed renogram.Results: One hundred fifty-two cases (95.0%) were performed by using a retroperitoneal approach, and 8 (5.0%) were performed by using a transperitoneal approach. Mean age was 45.3 +/- 17.4 years. Mean operating time was 139.4 +/- 45.6 minutes. A surgical drain was placed in 57 (71.3%) of the first 80 cases and 15 (18.8%) of the second 80 cases. Median hospital stay was one night (range 1-27). One case was converted to open pyeloplasty due to dense inflammatory tissue and one to robotic-assisted nephrectomy due to severe adhesions around the PUJ. There were no blood transfusions. There were six major (>grade 2 Clavien-Dindo) postoperative complications in four patients (2.5%). Two (1.3%) grade 3a complications, urine leak and pain after stent removal, required nephrostomy. There were three (1.9%) grade 3b complications: migrated stent requiring ureteroscopy, perirenal hematoma requiring open evacuation, and stent re-insertion. One (0.6%) grade 4 complication required ventilatory support on intensive care. Eighteen patients received follow-up at an alternative hospital, and 13 were lost to follow-up. Of the remaining cases, 94.5% were successful.Conclusions: R-RALP is a safe and effective treatment for PUJ obstruction allowing predictably rapid discharge from hospital without the need for a routine surgical drain. To our knowledge, our study represents the largest single institution experience on RALP using a retroperitoneal approach.
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收藏
页码:615 / 619
页数:5
相关论文
共 18 条
  • [1] Laparoscopic versus open pyeloplasty: Assessment of objective and subjective outcome
    Bauer, JJ
    Bishoff, JT
    Moore, RG
    Chen, RN
    Iverson, AJ
    Kavoussi, LR
    [J]. JOURNAL OF UROLOGY, 1999, 162 (03) : 692 - 695
  • [2] Systematic Review and Meta-Analysis of Robotic-Assisted versus Conventional Laparoscopic Pyeloplasty for Patients with Ureteropelvic Junction Obstruction: Effect on Operative Time, Length of Hospital Stay, Postoperative Complications, and Success Rate
    Braga, Luis H. P.
    Pace, Kenneth
    DeMaria, Jorge
    Lorenzo, Armando J.
    [J]. EUROPEAN UROLOGY, 2009, 56 (05) : 848 - 857
  • [3] Retroperitoneal and Transperitoneal Robot-Assisted Pyeloplasty in Adults: Techniques and Results
    Cestari, Andrea
    Buffi, Nicolo Maria
    Lista, Giuliana
    Sangalli, Mattia
    Scapaticci, Emanuele
    Fabbri, Fabio
    Lazzeri, Massimo
    Rigatti, Patrizio
    Guazzoni, Giorgio
    [J]. EUROPEAN UROLOGY, 2010, 58 (05) : 711 - 718
  • [4] Robotic Laparoscopic Pyeloplasty
    Chammas, Mario F., Jr.
    Mitre, Anuar I.
    Hubert, Nicolas
    Egrot, Christophe
    Hubert, Jacques
    [J]. JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS, 2014, 18 (01) : 110 - 115
  • [5] Meta-analysis of retroperitoneal vs transperitoneal laparoscopic and robot-assisted pyeloplasty for the management of pelvi-ureteric junction obstruction
    Chua, Michael E.
    Ming, Jessica M.
    Kim, Jin Kyu
    Milford, Karen L.
    Silangcruz, Jan Michael
    Ren, Lily
    Rickard, Mandy
    Lorenzo, Armando J.
    [J]. BJU INTERNATIONAL, 2021, 127 (06) : 687 - 702
  • [6] Meta-analysis of robot-assisted vs conventional laparoscopic and open pyeloplasty in children
    Cundy, Thomas P.
    Harling, Leanne
    Hughes-Hallett, Archie
    Mayer, Erik K.
    Najmaldin, Azad S.
    Athanasiou, Thanos
    Yang, Guang-Zhong
    Darzi, Ara
    [J]. BJU INTERNATIONAL, 2014, 114 (04) : 582 - 594
  • [7] Robotic Pyeloplasty: The University of California-Irvine Experience
    Etafy, Mohamed
    Pick, Donald
    Said, Shary
    Hsueh, Thomas
    Kerbl, David
    Mucksavage, Phillip
    Louie, Michael
    McDougall, Elspeth
    Clayman, Ralph
    [J]. JOURNAL OF UROLOGY, 2011, 185 (06) : 2196 - 2200
  • [8] Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system
    Gettman, MT
    Neururer, R
    Bartsch, G
    Peschel, R
    [J]. UROLOGY, 2002, 60 (03) : 509 - 513
  • [9] Outcome analysis of robotic pyeloplasty: a large single-centre experience
    Gupta, Narmada P.
    Nayyar, Rishi
    Hemal, Ashok K.
    Mukherjee, Satyadeep
    Kumar, Rajeev
    Dogra, Prem N.
    [J]. BJU INTERNATIONAL, 2010, 105 (07) : 980 - 983
  • [10] Is Retroperitoneal Approach Feasible for Robotic Dismembered Pyeloplasty: Initial Experience and Long-Term Results
    Kaouk, Jihad H.
    Hafron, Jason
    Parekattil, Sijo
    Moinzadeh, Alireza
    Stein, Robert
    Gill, Inderbir S.
    Hegarty, Nicholas
    [J]. JOURNAL OF ENDOUROLOGY, 2008, 22 (09) : 2153 - 2159