Single port robot-assisted laparoscopic pyeloplasty

Abstract

Objective

To demonstrate our step-by-step approach to performing a single-port (SP) robotic-assisted laparoscopic dismembered pyeloplasty.

Patient and Surgical Procedure

We present a 52-year-old female with symptomatic hydronephrosis secondary to ureteropelvic junction obstruction (UPJO). A computerized tomography (CT) scan confirmed severe right-sided hydronephrosis. The patient was taken to the operating room for a robotic SP dismembered pyeloplasty. With the patient in left lateral decubitus position, a 3 cm transverse incision was made at the right midclavicular line, two fingerbreadths cephalad to the umbilicus. The da Vinci SP access port was placed and the robot docked. The camera, and two fenestrated bipolar graspers were inserted at the six o'clock, nine o'clock and twelve o'clock positions, respectively. Small and large intestines were reflected until the ureteropelvic junction (UPJ) was exposed and a crossing vessel was observed. The ureter was transected and transposed along with the renal pelvis over the crossing vessel. The posterior anastomosis was performed and a double-J ureteral stent was placed. Finally, the anterior anastomosis was completed in an interrupted fashion.

Results

Patient was discharged the same day. No complications were observed during a 3 week follow-up.

Conclusion

The SP is a feasible alternative to the multiport (MP) to perform pyeloplasty successfully. This approach allowed for direct access to the surgical field without the need for redocking or extra assistant ports outside of our single incision.