Robotic Pyeloplasty
Since 2001, the robotic-assisted laparoscopic pyeloplasty has become one of the best ways to repair a ureteropelvic junction obstruction. This finding is described as a narrowing of the start of the tube (ureter) that drains urine from the kidney to the bladder (see figure below). The obstruction is usually caused by intrinsic scar tissue, lack of elasticity or a crossing blood vessel. Dr. Champ Weeks is one of the few surgeons utilizing the DaVinci surgical system ( www.intuitivesurgical.com ) in the northwest to perform this minimally invasive procedure.
The procedure is performed through 4 small 1cm incisions in the abdomen. The abdomen is inflated with carbon dioxide gas to develop a large working space and the laparoscope provides excellent magnified vision in order to perform such a delicate operation. The obstructed portion of the ureter is removed or by-passed and then reconnected to maintain the appropriate drainage and function of the kidney.
Before Pyeloplasty |
After Pyeloplasty
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The patient experience will include the need for a gentle bowel preparation and clears liquids only for the day before surgery. The patient will be admitted on the day of surgery and expect a 2 to 3 hour operative time before being admitted to the recovery unit for observation. They may expect to usually go home the following day after the operation. Typically, there is minimal blood loss and minor discomfort during patient recovery. The patient can expect to be walking the same day as surgery and starting a regular diet the day after the operation. A stent (hollow tube) will be placed into the kidney at the time of the surgery and will be removed by Dr. Weeks in the office approximately 4-6 weeks after the repair is completed. The stent allows the appropriate healing to occur without compromising the overall health of the kidney.
The patient may drive one week after the surgery, return to work in 2 weeks and resume all normal activities, including heavy lifting 4 weeks following surgery after clearance from Dr. Weeks. An imaging study is typically performed 3 months following the operation to confirm the repair.
Other treatment options for ureteropelvic junction obstruction include open surgical repair, endoscopic procedures that involve dilation of scar tissue or cutting the scar tissue with various options such as laser or cautery. These techniques all carry different success rates, risks and benefits and will be discussed with Dr. Weeks in detail prior to anyone's final decision for treatment.
Robotic Cystectomy
This technique is performed as a curative procedure for muscle invasive bladder cancer or recurrent high grade superficial disease of the bladder. It involves removal of the bladder and appropriate surrounding organs as well as removing appropriate lymph nodes for cancer staging and possible therapeutic advantages. As the bladder helps store the urine, there are several techniques available to create a new urinary storage unit. This exact technique will involve discussion and planning between the patient, their family and their urologic surgeon during the pre-operative visits and counseling. Dr. Weeks is the first surgeon in the state of Washington to have robotically performed this surgery with excellent results.
This davinci radical cystectomy is set up similar to the davinci prostatectomy except that we add an extra port (1 cm incision) to the right lower abdomen. Through this technique, we are able to dissect the ureters, the bladder, the prostate if performed in a male, the uterus if present in the female, lymph nodes as well as protect the nerves for erectile function and the muscle for urinary control if needed. Either through a small incision or possibly with the robotic technique, we are able to create the urinary diversion that is appropriate for the patient's specific case. The bladder, lymph nodes and appropriate other tissue will be removed through a small incision in the abdomen, depending on the technique used.
The benefits of the robotic technique are similar to all other minimally invasive procedures, including faster recovery, less blood loss, better visualization, less pain and a shorter hospital stay when compared to the open surgery technique.
Typically, the patient will spend 3-5 days with us in the hospital following the surgery, primarily teaching the patient how to care for their new urinary storage unit and waiting for the return of bowel function. The first night is usually in the ICU only for close observation and then transferred to the standard surgical recovery floor. Once here, we will encourage you to walk, start you on clear liquids and monitor your overall progress. Even after the patient is discharged home, there will be close follow up with Dr. Weeks in order to ensure proper recovery and patient comfort. |
