Laparoscopic pyeloplasty for ureteropelvic junction obstruction: comparing DaVinci robotic to classic laparoscopy.

The introduction of the DaVinci Robotic System, with 3D optics and improved range of motion of its instruments, may allow laparoscopic pyeloplasty to be performed at more centers for the treatment of UPJO. We compared 15 consecutive patients who underwent laparoscopic robotic pyeloplasty to our historic data on patients who underwent classical laparoscopic pyeloplasty. From November 2002 to September 2003, 15 patients underwent laparoscopic pyeloplasty with the DaVinci Robot. Fourteen patients underwent dismembered pyeloplasty and one underwent a Fenger pyeloplasty. A total of four trans-peritoneal ports were placed and a ureteral stent and Jackson-Pratt drain was placed in all cases. All cases were completed laparoscopically. The average blood loss was 66 and 95 cc for the robotic and classical laparoscopic groups, respectively. Mean operative time was 348 min (510-345) for the first 10 robotic cases, dropping to 240 min (455-120) in the last 5 cases. The classic group presented a mean operative time of 273 min even after 25 cases. No operative or post-operative complications were seen. The average hospital stay was 1.1 days (1-3) for the robotic group and 1.4 days (1-3) in the classic group. The seven degrees of motion of the DaVinci robotic system greatly enhances the precision in dissection, transection of tissue, and suturing of the UPJ, thus providing for decreased operative times and possible widespread use of this technique.

Michael Woods, Freddy Mendez, and Raju Thomas. Tulane University School of Medicine, Department of Urology, New Orleans, LA.