9224URO Individualized Management of Ureteropelvic Junction Obstruction During...

TITLE: Individualized Management of Ureteropelvic Junction Obstruction During Robot Assisted Laparoscopic Dismembered Pyeloplasty

Objective: The surgeon performing robot-assisted laparoscopic dismembered pyeloplasties (RALDP) must have adaptability and knowledge of various pyeloplasty techniques. The surgery should be tailored to an individual patients specific anatomy. We present 3 illustrative cases of RALP.

Methods: Digital video capturing is performed during all laparoscopic procedures. Video segments determined by the surgeon to have educational value are archived and later used to create educational videos.

Results: The video highlights the standard maneuvers used for RALDP using contemporary laparoscopic and robotic techniques. Laparoscopic devices, such as bipolar electrocautery, ultrasonic shears, and Hem-o-lok polymer ligating clips, are featured. Nephroscopy for the management of nephrolithiasis at the time of dismembered RALP is highlighted. Variations in the management of lower pole crossing vessels are demonstrated using techniques of cephalad transposition and posterior transposition. We have performed 52 robot-assisted laparoscopic pyeloplasties at our institution of which 41 are RALDP. Lower pole crossing vessels were transposed posteriorly in 13 patients and cephalad in 4 patients. On postoperative lasix renogram after RALDP, 95.1% (39/41) of the patients had a normal drainage curve. All patients with cephalad transposition of the lower pole vessels had no evidence of obstruction postoperatively. Flank pain resolved in 97.6% (40/41) of patients. The patient who had persistent flank pain had no evidence of obstruction on a postoperative lasix renogram.

Conclusions: This video clarifies the essential steps involved in a standard RALDP and the need for individualized management of patients with ureteropelvic junction obstruction.

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Authors: Michelle Lerner MD, Chandru Sundaram MD

Category:

Science & Technology

Tags:

• 'society
• of
• laparoendoscopic
• surgeons'
• SocietyLapSurgeons
• SLSUrology
• SLSPyeloplasty
• SLSEducation
• SLSEE09
• SLSRobotics
• laparoscopic
• laparoscopy
• SLS
• pyeloplasty
• 'robotic
• assisted'