Endoscopic assisted robotic pyelolithotomy and pyeloplasty for ureteropelvic junction obstruction and retrieval multiple large intrarenal calculi with ureteric access sheath

Abstract

Objective

The treatment of large intra renal stones with concomitant ureteropelvic junction obstruction (UPJO) can be managed with concurrent procedures. Endoscopic assisted robotic pyelolithotomy and pyeloplasty has been demonstrated to be safe and effective yet the use of a ureteric access sheath in such cases is not well documented. This article emphasises the use and advantages of a ureteric access sheath (UAS) to improve the control, decrease infection rates and minimise intrarenal pressures during endoscopic management in robotic pyelolithotomy and pyeloplasty.

Patients and Surgical Procedure

A 46-year-old female with a left ureteropelvic junction obstruction (UPJO) underwent an endoscopic assisted robotic pyelolithotomy and pyeloplasty for management of her UPJO and removal of stones. The renal pelvis was identified, incised, and a ureteric access sheath (UAS) was inserted through a robotic port into the renal pelvis and controlled using a robotic arm. Flexible pyeloscopy and subsequent basket removal of the stones was performed minimising any potential spillage of irrigation fluid into the abdominal cavity. The pyelotomy was closed using an Anderson-Hynes dismembered pyeloplasty.

Results

The operative time was 150 min and blood loss <50 ml. The patient was discharged on post-operative day 2 without any complications and a stable serum creatinine.

Conclusion

Endoscopic assisted robotic pyelolithotomy and pyeloplasty with a UAS is a safe and effective procedure for managing a concurrent UPJO and intra renal stones. This technique gives the surgeon maximal control of UAS positioning and location and may also decrease intrarenal pressures and reduce the risk of infection.