Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery

Fatih Atug, Erik P Castle, Scott V. Burgess, Raju Thomas

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

OBJECTIVE: To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy. PATIENTS AND METHODS: From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments. RESULTS: The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4-22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal. CONCLUSIONS: Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure.

Original languageEnglish (US)
Pages (from-to)1365-1368
Number of pages4
JournalBJU International
Volume96
Issue number9
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Kidney Calculi
Robotics
Laparoscopy
Operative Time
Conversion to Open Surgery
Kidney Pelvis
Suction
Bilateral Multicystic renal dysplasia
Catheters

Keywords

  • Laparoscopy
  • Pelvi-ureteric junction obstruction
  • Pyeloplasty
  • Renal calculi
  • Robotics

ASJC Scopus subject areas

  • Urology

Cite this

Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery. / Atug, Fatih; Castle, Erik P; Burgess, Scott V.; Thomas, Raju.

In: BJU International, Vol. 96, No. 9, 12.2005, p. 1365-1368.

Research output: Contribution to journalArticle

@article{c3f4f0548952462d84cd98f993dec915,
title = "Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery",
abstract = "OBJECTIVE: To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy. PATIENTS AND METHODS: From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments. RESULTS: The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4-22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal. CONCLUSIONS: Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure.",
keywords = "Laparoscopy, Pelvi-ureteric junction obstruction, Pyeloplasty, Renal calculi, Robotics",
author = "Fatih Atug and Castle, {Erik P} and Burgess, {Scott V.} and Raju Thomas",
year = "2005",
month = "12",
doi = "10.1111/j.1464-410X.2005.05819.x",
language = "English (US)",
volume = "96",
pages = "1365--1368",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery

AU - Atug, Fatih

AU - Castle, Erik P

AU - Burgess, Scott V.

AU - Thomas, Raju

PY - 2005/12

Y1 - 2005/12

N2 - OBJECTIVE: To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy. PATIENTS AND METHODS: From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments. RESULTS: The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4-22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal. CONCLUSIONS: Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure.

AB - OBJECTIVE: To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy. PATIENTS AND METHODS: From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments. RESULTS: The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4-22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal. CONCLUSIONS: Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure.

KW - Laparoscopy

KW - Pelvi-ureteric junction obstruction

KW - Pyeloplasty

KW - Renal calculi

KW - Robotics

UR - http://www.scopus.com/inward/record.url?scp=28544434154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=28544434154&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2005.05819.x

DO - 10.1111/j.1464-410X.2005.05819.x

M3 - Article

C2 - 16287459

AN - SCOPUS:28544434154

VL - 96

SP - 1365

EP - 1368

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 9

ER -