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. The obstruction is usually caused by intrinsic scar tissue (Figure 1), lack of elasticity or a crossing blood vessel(Figure 2). 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.
Figure 1. Scar tissue or loss of elasticity.
Before Pyeloplasty |
After Pyeloplasty
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Figure 2. Crossing blood vessel
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.
**In order to watch a brief video reviewing a robotic assisted laparoscopic pyeloplasty by Dr. Weeks, please click Robotic Pyeloplasty Video. Please be aware that this is a live surgery and content may not be suitable for all viewers.
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