Robotic Pyeloplasty

Robotic Surgery for Blockages of the Ureteropelvic Junction (UPJ)

Robotic Surgery for Blockages of the Ureteropelvic Junction (UPJ)

Robotic pyeloplasty is a minimally-invasive procedure done to remove a blockage occuring where the kidney meets the ureter—the ureteropelvic junction (UPJ). In a healthy urinary tract, urine drains from the kidney into the ureter, which then carries the urine down to the bladder. For various reasons, however, the UPJ can narrow or become blocked, causing urine to back up into the kidneys. In some cases this blockage is present at birth and becomes progressively worse over time. Blockages can also be caused by kidney stones or scar tissue. Symptoms may include pain in the flank area and blood in the urine. Left untreated, this condition can eventually lead to deterioration of kidney function or even loss of a kidney.

 

 

How Robotic Pyeloplasty is Performed

 

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In robotic pyeloplasty, the surgeon places the robotic instruments inside the patient through several small incisions in the abdomen. Often these incisions can be hidden in natural creases of the skin such as the belly button and pubic region. The surgeon uses these instruments to dissect the affected kidney and surgically remove the obstruction. The urinary tract is then surgically reconstructed to repair any damage to the ureter and kidney caused by the buildup in fluid pressure and prevent any obstructions from reoccurring in the future, after which the ureter and kidney are sutured back together. During the procedure, a retrieval device may also be used to remove any kidney stones from the kidney. In all cases, a stent is temporarily placed in the patient to help the healing process. The stent is then removed 4 weeks later in the doctor’s office.

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Advantages of Robotic Pyeloplasty

Robotic pyeloplasty is non-scarring. Managing this complex problem through traditional open surgery often requires a long incision in the lower abdomen. With robotic surgery, we are able to access the entire operative field from three small incisions, avoiding the need for a large, permanently disfiguring scar. As noted above, our surgeons are often able to hide two of these incisions completely—one in the patient’s belly button and one below the panty line.
Robotic pyeloplasty has a significantly shorter recovery time than open surgery. Because robotic pyeloplasty is less invasive than open surgery, patients who undergo the robotic procedure typically have shorter hospital stays and are able to return to their daily activities much sooner than those who have open pyeloplasty—often just 2 weeks after surgery, compared to 6 to 8 weeks for the open procedure. 
Robotic pyeloplasty is more precise and safer than laparoscopic surgery. Robotic surgery offers increased range of motion at the tips of each instrument, as well as scaling of motion and tremor-dampening technology. These factors, combined with the enhanced visualization provided by the da Vinci Si’s 3-D high definition camera, allow the surgeon to more precisely dissect and suture the ureter, which typically is only a quarter of an inch in diameter. The da Vinci also provides surgeons with a better suturing capability than can be achieved in open or laparoscopic surgery. In addition, recent studies indicate that the robotic procedure can be done with less blood loss, a shorter hospital stay, decreased complications and improved outcomes compared to laparoscopic pyeloplasty. Other potential benefits include less post-operative pain and less risk of infection.

Robotic Pyeloplasty at NYULMC

The robotic surgeons at NYU Langone Medical Center have been using robotics to treat ureteral pelvic junction obstructions since 2005, and have one of the nation’s longest and most successful track records in robotic pyeloplasty. Based on our experience, we believe that robotics offers an excellent minimally-invasive approach for managing obstructions of the ureteropelvic junction while maximizing the preservation of kidney function.

Research by NYULMC Doctors on Robotic Pyeloplasty

Meet Our Surgeons

Video Library

To watch videos of this procedure being performed by one of NYU Langone Medical
Center's robotic surgeons, click on the links below.