Laparoscopic Pyeloplasty

What is Pyeloplasty?

Pyeloplasty is common surgery in women to relieve urinary blockage in the area known as the uretero-pelvic junction (UPJ), where the pelvis and ureter tube meet. Normally urine forms in the kidney and flows into the area of the pelvis. Basically, pyeloplasty is the surgical reconstruction or revision of the renal pelvis (kidney) to drain and decompress the kidney. Several procedures have been developed over the years to treat this condition but pyeloplasty gives the highest chance of cure. The evidence to date suggests that laparoscopic pyeloplasty has an even higher success rate than traditional surgery.

The patient side cart sits at the bedside and holds the 4 robotic arms. The console is an ergonomically designed device that allows the surgeon’s movements to be translated into action utilizing the robotic arms. The robotic arms utilize EndoWrist™ instruments that have more degrees of freedom and precision than the human wrist.

Open Pyeloplasty : Pyeloplasty is an operation to repair a block in the ureter as it exits the kidney. It can be performed using either an open surgical approach or ‘keyhole’ (laparoscopic/robotic) surgery, and the type of surgery will depend on a number of factors, that will be discussed with you. There are other options, such as endopyelotomy, which may be considered in some circumstances. The specific reason you need an open pyeloplasty will be discussed with you.

Laparoscopic Pyeloplasty : Laparoscopic Pyeloplasty provides patients with a safe and effective way to perform reconstructive surgery of a narrowing or scarring where the ureter (the tube that drains urine from the kidney to the bladder) attaches to the kidney through a minimally invasive procedure. This operation is used to correct a blockage or narrowing of the ureter where it leaves the kidney. This abnormality is called a ureteropelvic junction (UPJ) obstruction which results in poor and sluggish drainage of urine from the kidney. UPJ obstruction can potentially cause abdominal and flank pain, stones, infection, high blood pressure and deterioration of kidney function.

Robotic Assisted Pyeloplasty: Robotic-assisted pyeloplasty is performed under general anaesthetic. This keyhole method uses 3 to 4 small cuts, through which a camera and surgical instruments can be passed. The camera sends pictures to a TV screen so the surgeon can see the kidney and surrounding tissue. It is very similar to laparoscopic surgery, the difference is that the surgeon controls the instruments from a console away from the operating table. These instruments are easier to move around than standard laparoscopic surgery. The diagram below shows an operating theatre set up with the robotic equipment.

Percutaneous Antegrade Endopyelotomy : In this an incision is made directly over the region of upper pole of kidney. The nephroscope is inserted through the incision upto the renal pelvis and narrowed area. Micro instruments are then guided through the scope with the help of a camera and the narrowed portion is cut. The ureter and the pelvis are stitched up and a stent is positioned from the pelvis up to the bladder. The stent is kept in place for about 4-6 weeks. Faster recovery due to a small incision and lesser blood loss is the main advantage of the procedure.

• Retrograde Endopyelotomy : The procedure is same as above except that instead of a nephroscope, a ureteroscope is used which is inserted through the bladder and guided up to the renal pelvis. The narrowed part is removed and the stent is place from the bladder to the pelvis. This procedure can be performed in an outpatient setting.

Your surgeon will have explained that your urine is not draining from the kidney properly because of a narrowing at the pelviureteric junction (PUJ). This may be causing you pain. He has chosen this method of surgery to reduce the length of your recovery and to allow you to resume a normal life in a shorter period of time when compared to the more conventional open method of repairing the narrowing.

You may want to ask some questions before your treatment begins:

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