Robot-Assisted Simultaneous Pyeloplasty and Ureteric Reimplantation for Unilateral Double Obstruction of the Ureter: Technical feasibility, Tips and Tricks.

ABSTRACT

OBJECTIVE: To highlight the feasibility and technical details of performing simultaneous ipsilateral pyeloplasty and ureteric re-implantation for simultaneous proximal and distal obstruction of the ureter. METHODS: Two patients with preoperative diagnosis of proximal and distal ureteric obstruction underwent robot-assisted simultaneous pyeloplasty and ureteric re-implantation. The patients were placed in right lateral oblique position and pyeloplasty was performed in standard manner. In both cases, Double J stent could not be negotiated beyond the vesicoureteric junction into the bladder. The robot was dedocked and recentred around different ports to successfully perform uretero-neocystostomy over a 4.8 F double J stent. RESULTS: The mean operative times were 154 minutes with operative blood loss of approximately 50 ml. The postoperative convalescence was good in both cases and Double J stents were removed after 6 weeks. Follow-up diuretic renograms demonstrated stable renal function with unobstructed drainage. CONCLUSION: Simultaneous repair of ipsilateral pelviureteric and vesicoureteric junction obstruction is safe and feasible contrary to traditional teachings. To the best of our knowledge this is the first description of robotic simultaneous pyeloplasty and ureteric reimplantation.