V909: Robotic Flap Pyeloplasty for An Extended Length Ureteral Stricture Non-amenable to Dismembered Pyeloplasty
VideoIntroduction and Objectives
Repair of Ureteropelvic junction (UPJ) obstruction is traditionally done either by dismembered pyeloplasty or a non-dismembered flap pyeloplasty. Dismembered pyeloplasty requires the division and re-anastomosis of the ureter. This procedure has a very high success rate but is unsuitable for obstructions that involve long strictures. Conversely non-dismembered flap pyeloplasty requires the incision of the ureter along the length of the stenosis and creation of a broad flap from the renal pelvis, and subsequent anastomosis of this flap. While this procedure is more complex, it allows correction of relatively long ureteral narrowing.
In this video a 19 y/o female patient with a proximal ureteric stricture 4-5 cm in length causing left hydronephrosis was taken to the operating room for robotic assisted non-dismembered flap pyeloplasty. The da Vinci surgical system was used for dissection and repair of the UPJ obstruction. The obstructed ureter was first incised along the length of the stricture. A vertical flap from the anterior renal pelvis was then used to tubularize the proximal ureter. A tension free water tight anastomosis was created.
The patient successfully underwent the procedure without complications and experienced minimal blood loss. She convalesced without issue and was discharged post-operative day 2. At 1 month follow up the patient had fully recovered and was asymptomatic.
This video demonstrates that robotic assisted non-dismembered flap pyeloplasty can be effectively used for longer strictures that would preclude use of the traditional dismembered approach.