Laparoscopic Repair of Kidney Obstruction (Laparoscopic Pyeloplasty)
Indications
A kidney obstructed at the level where the kidney meets the ureter is referred to as a ureteral pelvic junction obstruction (UPJ obstruction). UPJ obstruction may be caused by several factors. The most common cause is congenital; the patient is born with the obstruction. Other causes include stone disease, infection and trauma.
Patients with a UPJ obstruction may develop pain, infection, or blood in the urine causing them to visit their physician. Other times it may be discovered incidentally on a x-ray performed for some other reason. In either case a thorough work up is required to determine the etiology of the obstruction and the best technique to correct it. When the repair requires that the UPJ be reconfigured to form a funnel a Robotic approach may be utilized.
Procedure
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The laparoscopic technique employs four to five small cylindrical tubes called trochars. The trochars allow entry of a video-telescope, called a laparoscope, to view the operative field which is magnified to aid in surgical intervention. Accessory small trochars allow the introduction of fine laparoscopic instruments necessary to perform surgery. The same procedure that would be performed using an open technique, is performed laparoscopically with the assistance of the da Vinci robot. The obstructed portion of ureter is identified and removed. The ureter and renal pelvis are reconstructed in such a way to improve drainage.
Video procedures:
Results
Long term results of laparoscopic pyeloplasty have confirmed that complications remain low, blood loss is minimal and outcomes are excellent paralleling those performed using the standard open technique. Advantages to the laparoscopic and robotic technique include magnification of the operative field for the surgeon and significantly less pain and quicker recuperation time for the patient compared to open surgery.
