Robot-assisted da Vinci renal pyeloplasty for ureteropelvic junction obstruction
In patients suffering from a narrowing of the area between the renal pelvis and the ureter (ureteropelvic junction obstruction), the performance of a renal pyeloplasty is recommended. The aim of the operation is to restore the unobstructed outflow of urine from the dilated renal pelvis and thus preserve kidney function. The surgical access routes are open surgery via a flank incision or laparoscopically, which can also be performed using a surgical robot.
The advantages of robot-assisted da Vinci surgery in this procedure are that only very small incisions are required, a precise reconstruction of the renal pelvis can be performed using a three-dimensional, magnified view of the surgical site, and the patient can expect hardly any pain. As a reconstructive procedure, renal pelvic plastic surgery ideal for a robot-assisted da Vinci procedure.
Questions about the diagnosis and treatment of ureteropelvic junction obstruction
Urine is produced in the kidneys and passes into the renal pelvis. From there it flows through the ureter into the bladder. At the transition from the renal pelvis to the ureter, there is one of three natural constrictions of the ureter, which under normal circumstances does not result in any impairment of urine flow. However, if this results in an obstruction to the flow of urine, it is known as ureteropelvic junction obstruction.
If the patient suffers from flank pain, for example, a renal pyeloplasty may be necessary. The same applies if the examination results show a restriction of urine transport or a deterioration of kidney function.
Surgery on the kidney is performed to remove the constriction at the transition from the renal pelvis to the ureter. This procedure is performed by an experienced urology specialist. The reconstructive procedure widens the area by sewing in the body’s own tissue from the renal pelvis in the area of the former constriction.
Often, after the procedure, the renal calices or the renal pelvis continue to widen as a sign of chronic dilatation. If there are no complaints or urine stasis, then this finding has no therapeutic consequences and only needs to be inspected. However, if the patient has side (flank) pain or if kidney function deteriorates, renewed treatment must be considered.
Short info on robot-assisted da Vinci renal pyeloplasty
|Indication||Site of constriction at the transition of the renal pelvis to the ureter|
|Procedure||Removal of the constriction through minimally invasive access, tension-free suturing of the of the ureter to the renal pelvis|
|Surgery time||Approx. 2 hours|
|Clinic stay||5-7 days|
|Note||General anaesthesia, splinting of the ureter for approx. 6 weeks|
Questions about robot-assisted da Vinci renal pyeloplasty
Inpatient admission for robot-assisted da Vinci renal pyeloplasty takes place the day before the procedure. The procedure takes place under general anaesthesia. The minimally invasive instruments of the robot are inserted into the abdominal cavity using the keyhole technique. Using three-dimensional vision, the surgeon can see the constriction at the junction of the renal pelvis and the ureter. After the constriction is removed, the robot-assisted procedure allows the surgeon to make a precise suture between the renal pelvis and the ureter. The resulting anastomosis is secured with an internal ureteral splint. This splint remains in place for about 6 weeks and is removed endoscopically during a later outpatient treatment. The entire inpatient stay lasts about 5-7 days.
In contract to conventional laparoscopic renal pyeloplasty, robot-assisted da Vinci renal pyeloplasty is performed under high magnification of the surgical site. This allows the tissue to be prepared more precisely. In addition, robot-assisted renal pyeloplasty allows for shorter surgical procedure time due to greater mobility of the instruments.
In general, professional activities corresponding to an office job are possible again 2-3 weeks after the procedure. The inserted ureteral splint is removed approx. 6 weeks after the renal pelvic plastic surgery. After that, the urine outflow from the renal pelvis is checked. Physical activities, sport, and heavier physical exertion can then be resumed. Goldstadt Private Clinic provides outpatient care after discharge from the inpatient treatment.
The renal pyeloplasty is performed under general anaesthesia. Due to the very small incisions in the robot-assisted da Vinci renal pyeloplasty, practically no pain is expected after the procedure. The removal of the ureteral splint after approx. 6 weeks is carried out by means of an outpatient, if necessary flexible, cystoscopy.