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Robotic pyeloplasty

Robotic pyeloplasty is a keyhole robotic surgery procedure used to repair a narrowing to the drainage tube of the kidney, at the point where the renal pelvis meets the ureter (the muscular tube carrying urine from the kidney to the bladder). This condition is called PUJ obstruction, and presents clinically with pain over the affected kidney, especially after drinking large volumes of fluids. Sometimes the cause is a crossing blood vessel, which compresses this part of the tube, and in other patients it is due to internal scarring, sometimes present from early on in life.

The procedure is carried out through 4 small incisions measuring 1-2 cm through which the robotic camera and instruments are introduced into the abdominal cavity. The kidney is exposed by carefully removing overlying bowel, and the area of the narrowed tube is dissected free. The surgeon divides the tube in two, removing the narrowed segment, and then rejoins the two ends together with fine sutures using a technique to create a wide-mouthed join that will usually not narrow down again. A small surgical splint, called a stent and made of silicone, is placed inside the ureter tube running from the kidney to the bladder. This stent supports the join and helps prevent a urine leak after surgery. The stent is usually left in place for 6 weeks, and then removed with a short endoscopic procedure under local anaesthetic.

Recovery from the procedure is usually rapid, with patients able to go home on the second or third day after surgery. Patients are advised to avoid strenuous activity for 6 weeks afterwards, but can drive within 1-2 weeks.

The procedure is generally very safe, but some uncommon complications include damage to adjacent organs including bowel, liver and spleen, damage to blood vessels, urine leak or bleeding afterwards, and renarrowing of the join. The operation generally has a 85% long term success rate. After removal of the stent in 6 weeks, patients are seen again by their urologists, often with further imaging tests, to ensure successful outcomes and exclude future problems.