ROBOTIC TRANSMESENTERIC RIGHT PYELOPLASTY

Introduction & Objectives: Pyeloplasty is the standard treatment in case of ureteropelvic junction obstruction (UPJ). This procedure can be done either by open surgery or laparoscopically or with a robotic approach. Laparoscopic and robotic approach can be applied either with a transperitoneal or with a retroperitoneal way. In this video we show a robotic right pyeloplasty with direct approach to the UPJ. Materials & Methods: A 37 years old patient presenting right flank pain. He underwent an ultrasound scan and a CT urography that showed an ureteropelvic junction obstruction with big redundant pelvis and grade III hydronephrosis. Thus we decided to perform a robotic transperitoneal right pyeloplasty. A total of 4 trocars are used: 1 for the optic, 2 for the robotic arms and 1 for the assistant.. The renal pelvis can be seen through the meso. The peritoneum is incised longitudinally for two centimetres. The renal pelvis and the stenotic junction are dissected. The pelvis is incised and the stenotic junction is transacted. The ureter is spatulated distally for two centimetres. An Anderson-Hynes pyeloplasty is performed using a 4-0 vicryl stitch. During the pyeloplasty a double J stent is inserted to protect the anastomosis. The peritoneum is close and a drainage is positioned in the retroperitoneal cavity. Results: Operative time was 90 minutes. No intraoperative complications occurred. Drainage was taken out postoperative day two. Postoperative stay was uneventfully. Three weeks after surgery the double J stent was removed.. Three months after surgery patient was asymptomatic and the ultrasonography showed absence of hydronephrosis. Conclusions: robotic right pyeloplasty is a feasible and effective way to treat ureteropelvic junction obstruction. In case of a big redundant pelvis the transperitoneal transmesenteric approach can be a good way to perform this procedure.