Hemal Ashok K, Mishra Saurabh, Mukharjee Satydip, Suryavanshi Manav
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Int J Urol. 2008 Aug;15(8):744-6. doi: 10.1111/j.1442-2042.2008.02091.x.
To review our experience of robotic redo pyeloplasty as a salvage procedure in previously failed repair of ureteropelvic junction (UPJ) obstruction. In one year, robot-assisted laparoscopic pyeloplasty was performed in nine patients for previously failed open pyeloplasty. Four of these patients had undergone additional retrograde endopyelotomy following failed repair, prior to being referred to us. The mean age was 16.4 years. All patients presented with persistent flank pain and an obstructive pattern on diuretic renogram. Robotic redo pyeloplasty could be performed successfully in all patients without any technical problems. Intraoperative findings for cause of UPJ obstruction were peri-ureteral fibrosis, narrow ureter, anterior crossing vessels, and redundant pelvis. The mean hospital stay was 3.4 days (2-5 days). All patients had improvement in symptoms and the nuclear scan showed non-obstructive drainage. Robot assisted redo pyeloplasty enables complex repair in patients with previous failed cases of UPJ obstruction repair. Three-dimensional magnified vision, and a dynamic articulated endowrist, allows fine dissection in the fibrosed area and precise suturing in an ergonomic fashion with a success equivalent to open surgery.
回顾我们将机器人辅助再手术肾盂成形术作为输尿管肾盂连接部（UPJ）梗阻既往修复失败后的挽救手术的经验。在一年时间里，9例既往开放性肾盂成形术失败的患者接受了机器人辅助腹腔镜肾盂成形术。其中4例患者在修复失败后还接受了逆行肾盂内切开术，之后才转诊至我们这里。平均年龄为16.4岁。所有患者均表现为持续性胁腹痛，利尿肾图呈梗阻型。所有患者均成功实施了机器人辅助再手术肾盂成形术，未出现任何技术问题。术中发现UPJ梗阻的原因有输尿管周围纤维化、输尿管狭窄、前交叉血管和肾盂积水。平均住院时间为3.4天（2 - 5天）。所有患者症状均有改善，核素扫描显示无梗阻性引流。机器人辅助再手术肾盂成形术能够对既往UPJ梗阻修复失败的患者进行复杂修复。三维放大视野和动态关节腕部使得在纤维化区域能够进行精细解剖，并以符合人体工程学的方式精确缝合，成功率与开放手术相当。
