Understanding Robotic Pyeloplasty
Blockage of urine outflow from the kidney is known as a ureteropelvic
junction (UPJ) obstruction; it typically is caused by congenital scarring
or a blood vessel pressing on the ureter. This can result in pain,
infection, kidney stones and loss of kidney function.
Pyeloplasty, or surgical removal of the UPJ obstruction, returns the
outflow of urine to normal. Traditionally, the procedure has been performed
as an open surgery through an 8-12 inch incision in the flank. (see figure
1a and 1b) A minimally invasive alternative, robotic pyeloplasty has been
demonstrated to have success equal to that of traditional open surgery but
with added benefits: less postoperative pain, a shorter hospital stay,
earlier return to normal activity and a better cosmetic result.1-2
Traditional open kidney surgery is performed through an 8-12 inch incision
extending from the ribs towards the abdomen. A portion of one of the ribs
is usually removed as part of the surgery.
Robotic pyeloplasty requires a general anesthetic. First, 3 tiny
"keyhole" incisions, each 1cm, are made in the patient's abdomen. A
laparoscopic camera and thin, specialized instruments are placed through
these incisions. The area of obstruction then is isolated and either
removed or repaired using laparoscopic suturing techniques. A ureteral
stent is left in place for 3 weeks following the surgery and removed in the
urologist's office. (see figure 2)
Advantages over open surgery
Shorter hospital stay
Better cosmetic result
Patients should expect a greater than 95% success rate,1-2 equal to that of
the open procedure if performed by an experienced surgeon such as those at
Robotic-assisted pyeloplasty is performed through 3 small incisions in the
Typical blood loss is 100cc. Blood transfusions are extremely rare.
What to Expect after Surgery
The typical stay is 2 days.
Patients resume normal eating as they recover in the first day after
surgery or soon thereafter.
Pain is managed immediately with an intravenous patient controlled
analgesia pump, which is removed and replaced by pills the day after
surgery. Upon discharge, pain pills are given for several days, after which
over-the-counter acetaminophen or ibuprofen are usually all that is needed.
A urinary catheter is left in place for one or two days following the
surgery and then removed.
A small drain placed in the area of the kidney is usually removed the
second day after surgery.
Time to complete recovery is typically 3-4 weeks compared with 8 weeks for
A: kidney, renal pelvis, and ureter shown prior to pyeloplasty. Note the
distended renal pelvis as a result of urine obstruction and the ureteral
stent placed just prior to the procedure.
B: the obstructed portion of the ureter has been removed and the ureter is
sutured back to the renal pelvis using laparoscopic suturing techniques.
C: This is the kidney and ureter following the procedure. A smooth funnel
shape is recreated to allow urine to flow freely from the kidney. The
ureteral stent is removed in 3 weeks.
Patients will follow-up with their surgeon 1 month after the operation for
a routine visit, then at 3, 12 and 24 months with nuclear renal imaging and
ultrasounds of the kidney. Appointments can easily be conducted over the
phone for patients living outside the Boston area, including international
1. Moon DA El-Shazley MA, Chang CM, Gianduzzo TR, Eden CG. "Laparoscopic
pyeloplasty: evolution of a new gold standard." Urology, May 2006: 67:
2. Romero FR, Wagner AA, Trapp C, Permpongkosol S, Link RE, Kavoussi LR.
"Tansmesenteric laparoscopic pyeloplasty." The Journal of Urology, 2006 in