Thiel David D
Department of Urology, Mayo Clinic, 3 East Urology, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
ISRN Urol. 2012;2012:291235. doi: 10.5402/2012/291235. Epub 2012 Oct 30.
Pyeloplasty is the gold standard therapy for ureteropelvic junction obstruction. Robotic assisted pyeloplasty has been widely adopted by urologists with and without prior laparoscopic pyeloplasty experience. However, difficult situations encountered during robotic assisted pyeloplasty can significantly add to the difficulty of the operation. This paper provides tips for patient positioning, port placement, robot docking, and intraoperative dissection and repair in patients with the difficult situations of obesity, large floppy liver, difficult to reflect colon (transmesenteric pyeloplasty), crossing vessels, large calculi, and previous attempts at ureteropelvic junction repair. Techniques presented in this paper may aid in the successful completion of robotic assisted pyeloplasty in the face of the difficult situations noted above.
肾盂成形术是治疗输尿管肾盂连接处梗阻的金标准疗法。机器人辅助肾盂成形术已被有或没有腹腔镜肾盂成形术经验的泌尿外科医生广泛采用。然而，机器人辅助肾盂成形术中遇到的困难情况会显著增加手术难度。本文针对肥胖、肝脏大且松软、结肠难以翻转（经肠系膜肾盂成形术）、血管交叉、结石大以及既往有输尿管肾盂连接处修复尝试等困难情况的患者，提供了患者体位摆放、端口置入、机器人对接以及术中解剖和修复的技巧。本文介绍的技术可能有助于在面对上述困难情况时成功完成机器人辅助肾盂成形术。
