Robotic Assisted Laparoscopic Pyeloplasty - the Initial Australasian Experience

Introduction: Laparoscopic pyeloplasty is a proven treatment for PUJ obstruction but can be difficult to master due to the laparoscopic suturing involved. The Da Vinci operating system (Intuiative, CA, USA) has been used for other urological procedures, notable radical prostatectomy, and has been shown to reduce the learning curve for laparoscopically naïve surgeons. The initial Australasian experience of robotic assisted laparoscopic pyeloplasty is presented. Patients and Methods: Six patients with PUJ obstruction requiring treatment (five primary, one recurrent) who were suitable for pyeloplasty were offered the option of having their surgery using the Da Vinci operating system. The initial dissection was undertaken laparoscopically and the robot used for dismemberment and anastomosis. Results: Five of the six had their surgery completed robotically; open conversion was required in the patient who had undergone previous open pyeloplasty, the same patient required a blood transfusion due to haemolysis. Other surgical parameters (length of stay, operating time, complications, return to normal activities) were all in an acceptable range. Six month postoperative nuclear renography revealed no obstruction in any patient and all were asymptomatic. Conclusion: Robotic assisted pyeloplasty is technically feasible for the surgeon with little experience of laparoscopic suturing. Operative data and early follow-up results are encouraging.