Departments of Urology, Epworth Hospital, Richmond, VIC, Australia.
Department of Urology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia.
J Robot Surg. 2010 Jan;3(4):209-13. doi: 10.1007/s11701-009-0163-5. Epub 2009 Nov 27.
Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci(®) surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci(®) surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruction. Peri-operative and outcome data were recorded prospectively. Twenty-four patients underwent RALPY over a 4-year period. The mean age was 46.6 (range 18-76) years. The mean total operative time was 211 min (range 150-317 min) with an anastomotic time of 44 min (range 30-55 min). The mean estimated blood loss was 56 ml (10-150 ml) and there was one temporary urine leak managed by 24 h of urethral catheterization. The median length of stay was 4 (2-10) days. Patients underwent diuretic renography at 6 months post surgery, and satisfactory renal drainage was demonstrated in all cases. RALPY is a feasible and safe option for the management of UPJ obstruction. This technology may reduce the difficulty associated with complex laparoscopic suturing and facilitate shorter operative times with excellent outcomes. This is now our preferred approach for all patients opting for surgical management of UPJ obstruction.
腹腔镜离断肾盂成形术治疗肾盂输尿管连接部（UPJ）梗阻的成功率超过 90%。然而，腹腔镜腔内缝合仍然具有技术挑战性，可能导致手术时间延长。使用达芬奇（®）手术系统（直觉外科，加利福尼亚州，美国）进行机器人辅助缝合可能会降低腔内缝合相关的难度。我们机构对接受经腹腔机器人辅助腹腔镜肾盂成形术（RALPY）的成年人使用达芬奇（®）手术系统辅助腔内缝合。最初，机器人仅用于吻合，但在系列的后期，机器人用于所有的解剖和重建部分。记录了围手术期和结果数据。在 4 年期间，有 24 名患者接受了 RALPY。平均年龄为 46.6 岁（范围 18-76 岁）。平均总手术时间为 211 分钟（范围 150-317 分钟），吻合时间为 44 分钟（范围 30-55 分钟）。平均估计出血量为 56 毫升（10-150 毫升），有 1 例暂时性尿漏，通过留置 24 小时导尿管进行处理。中位住院时间为 4 天（2-10 天）。患者在手术后 6 个月接受利尿剂肾图检查，所有病例均显示满意的肾功能引流。RALPY 是治疗 UPJ 梗阻的一种可行且安全的选择。该技术可能会降低复杂腹腔镜缝合相关的难度，并通过出色的结果实现更短的手术时间。这是我们现在为所有选择手术治疗 UPJ 梗阻的患者提供的首选方法。
