Kumar Sunil, Bhirud Deepak Prakash, Mittal Ankur, Navriya Shiv Charan, Ranjan Satish Kumar, Mammen Kim Jacob
Department of Urology, AIIMS, Rishikesh, Uttarakhand, India.
J Minim Access Surg. 2021 Apr-Jun;17(2):202-207. doi: 10.4103/jmas.JMAS_10_20.
Anderson-Hynes pyeloplasty has been gold standard in the management of pelviureteric junction obstruction (PUJO). It has evolved from open to laparoscopic and now robotic surgery. Open surgery has its drawback of long incision and scar mark, significant post-operative pain and long hospital stay. The main limitation of laparoscopic surgery had been the difficulty in endosuturing. Robotic surgery has incorporated the minimal access method of laparoscopy and endowrist movement of open surgery to overcome the challenge of intracorporeal suturing. Here, we present our initial experience of robotic pyeloplasty.
A total of 30 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) over 19 months. Diagnosis of PUJO was made by computed tomography urography, diuretic renogram and retrograde pyelogram in selected patients. All patients underwent RALP by colon reflecting approach. Post-operative evaluation was done by DTPA scan at 3- and 6-month follow-up. Data were analysed after a mean follow-up of 11 months.
The mean operative time was 148 min and the mean hospital stay was 3.5 days. While 93% of the patients showed objective improvement in their drainage pattern on DTPA renogram, 90% of the patients were symptom-free at the end of 6 months.
Robotic pyeloplasty is a safe and easily conquerable technique with comparable outcomes in the hands of surgeons who are beginners in this technique.
安德森-海因斯肾盂成形术一直是治疗肾盂输尿管连接部梗阻（PUJO）的金标准。它已从开放手术发展到腹腔镜手术，现在又发展到机器人手术。开放手术存在切口长、有瘢痕、术后疼痛明显以及住院时间长等缺点。腹腔镜手术的主要局限性在于腔内缝合困难。机器人手术结合了腹腔镜的微创方法和开放手术的腕部运动，以克服体内缝合的挑战。在此，我们介绍我们机器人肾盂成形术的初步经验。
在19个月期间，共有30例患者接受了机器人辅助腹腔镜肾盂成形术（RALP）。部分患者通过计算机断层扫描尿路造影、利尿肾图和逆行肾盂造影诊断为PUJO。所有患者均采用结肠后入路进行RALP。术后在3个月和6个月随访时通过二巯基丁二酸（DTPA）扫描进行评估。在平均随访11个月后对数据进行分析。
平均手术时间为148分钟，平均住院时间为3.5天。93%的患者在DTPA肾图上显示引流模式有客观改善，90%的患者在6个月末无症状。
对于这项技术的初学者而言，机器人肾盂成形术是一种安全且易于掌握的技术，其效果相当。
