What is Robotic-Assisted Pyeloplasty?
Robotic-assisted pyeloplasty is a surgical procedure for the treatment of a blockage in the ureteropelvic junction (UPJ), called ureteropelvic junction obstruction. It is performed using robotic surgical instruments - most commonly the da Vinci robotic surgical system - through tiny incisions in the abdomen. Robotic-assisted pyeloplasty offers improved precision and a faster recovery.
The da Vinci robotic surgical system consists of three components: the surgeon’s console, robotic arms, and a video tower. The surgeon sits at the console and controls the movements of the robotic arms which are attached to the video tower. One robotic arm holds the camera while the other arms control the surgical instruments guided into your abdomen through small openings called ports. The camera provides a high-definition, 3D magnified view of the inside of your body for your surgeon to view at the console.
What is Ureteropelvic Junction Obstruction?
The kidneys filter the blood to produce urine, which passes through the renal pelvis, a funnel-shaped area on each kidney, through tubes called ureters that lead to the bladder. A blockage can sometimes occur at the junction of the renal pelvis and the ureter called the ureteropelvic junction (UPJ), causing urine to accumulate and damage the kidney.
UPJ obstruction can occur due to an abnormally developed UPJ, the presence of kidney stones, scar formation, infection, backflow of urine (vesicoureteral reflux), or a vessel that compresses the area.
Pre-surgical Preparation for Robotic-Assisted Pyeloplasty
You will need to undergo a complete medical check-up prior to surgery. Your lab reports will be checked by your doctor. You will be given pre-operative instructions to follow until the date of the surgery. This may include certain dietary restrictions. You should follow your doctor’s instructions for optimal results.
Procedure: Robotic-Assisted Pyeloplasty
For a robotic-assisted pyeloplasty, you will be placed either lying on your side, or on your back, also known as the supine position.
- General anaesthesia is administered.
- 3-5 incisions smaller than 1 cm are made in your abdomen.
- Through the incisions, your surgeon passes special surgical instruments called trocars that provide ports for insertion of the da Vinci robotic instruments.
- Images of the internal organs are visualized on a monitor connected to the da Vinci System.
- Your surgeon operates the da Vinci System from the console and the robotic arms connected to it bend and rotate the surgical instruments as per the surgeon’s instructions.
- The blockage in the ureteropelvic junction is identified and resected (removed).
- The remaining healthy ends of the UPJ are sutured.
- A stent may be inserted to keep the ureter open and stable during the healing process and is removed later.
- The incisions are closed, and a dressing is applied.
Post-Operative Care for Robotic-Assisted Pyeloplasty
You may be required to stay in the hospital for monitoring for 1-2 days following your surgery.
- A urinary catheter is inserted at the time of surgery to drain your bladder and measure urine output for the first 24-48 hours following your surgery. It is removed by your nurse once you are able to walk comfortably.
- You may have blood specks in your urine while the catheter is in place. These will disappear after the catheter is removed.
- You will be given liquid food or soft food for a few days. Later, as you recover, you can advance to solid foods.
- You may develop constipation or gas for a few days.
- You are encouraged to walk and move around to prevent blood clots. However, you should avoid heavy lifting or exertion for around 4 weeks following surgery.
- Your doctor will give you pain-relieving medications to minimize post-operative pain.
You should visit your doctor a few months after your surgery for a complete medical check-up. Discuss with your healthcare provider if you have experienced any abnormal symptoms.
What are the Benefits of Robotic-Assisted Pyeloplasty?
The many benefits of robotic-assisted pyeloplasty include:
- Improved visualization that enhances surgical precision
- Smaller incisions
- Minimal scar formation
- Shorter operating time
- Shorter hospital stay
- Faster recovery
- Early return to your daily activities
What are the Risks and Complications of Robotic-Assisted Pyeloplasty?
As with any surgery, robotic-assisted pyeloplasty may involve certain risks and complications such as injury to the nearby organs, bleeding, infection, and recurrence of kidney obstruction.