Robotic Upper Urinary Tract Reconstruction

Robotic Upper Urinary Tract Reconstruction: Robotic Pyeloplasty and Related Procedures

Robotic Surgery for Ureteropelvic Junction Obstruction

Robotic pyeloplasty is performed for ureteropelvic junction obstruction (UPJO) due to either congenital or acquired causes. It offers significant advantage over traditional open pyeloplasty because the entire procedure can be performed through four small key-hole incisions versus a painful muscle-splitting flank incision. The procedure is performed similarly to a robotic radical or partial nephrectomy in the initial steps of robotic set-up and exposure of the kidney. Using robotic-assistance a classic Anderson-Hynes dismembered pyeloplasty can be performed. In some instances, patients form stones in the affected kidney due to chronic urinary stasis. These can be easily removed during robotic pyeloplasty by advancing a flexible cystoscope or ureteroscope through the assisted trochar and into the opening (pyelotomy) in the renal pelvis.

Other procedures that are performed with robotic assistance include surgery for ureteral stricture disease or upper tract transitional cell carcinoma (UT-TCC) not requiring nephroureterectomy such as ureteroureterostomy or distal ureterectomy, ureteral reimplant and psoas hitch. In some instances where a large portion of the ureter is excised a Boari flap may be required (a bladder flap that can be refashioned to span much of the distance between the kidney and bladder). For more information on the general steps of robotic pyeloplasty and upper urinary tract reconstruction see Robotic Partial Nephrectomy.