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Pyeloplasty is the operation done to correct the blockage or narrowing of the upper most part of the ureter where it leaves the kidney. The abnormality (narrowing) is called Ureteropelvic Junction Obstruction (UPJO). UPJO results in poor and sluggish drainage of urine from the kidney and may be responsible for recurrent pain, stone in the affected kidney, infection, high blood pressure and deterioration of the kidney function.

Robotic pyeloplasty involve the precise removal of the narrow or scarred segment of the ureter (ureteropelvic junction or UPJ) and rejoining the healthy segment of the upper ureter to the pelvis.

Robotic pyeloplasty
is an excellent minimally invasive surgical alternative to an open pyeloplasty. When compared to the conventional open technique the robotic pyeloplasty has resulted in a significantly-
                                                     

  • Shorter hospital stay
  • Quicker return to daily activities
  • Reduced pain
  • Lesser risk of infection
  • Better cosmetic result
  • Avoidance of a large scar along with its potential complications like incisional hernia

    Using the surgical robot, the surgeons can achieve precise removal of the blocked segment of ureter along with excellent reconstruction.

The Surgery

Robotic pyeloplasty is performed under a general anesthetic. The typical length of the operation is 3-4 hours.

The surgery is performed through 3 small (5-12mm) incisions made in the abdomen. The robotic arms with its attached instruments (that includes a camera) are passed through these “keyholes”. The camera provides the surgeon a 3-dimensional, high definition, magnified view of the tissues inside the body. Various types of Endowrist instruments with capability to move in various directions allow the surgeon to precisely dissect the junction of the ureter and kidney pelves and subsequently repair the blocked or narrow segment, without having to place his hands into the abdomen.

A small hollow tube (called a ureteral stent) is left inside the ureter at the end of the procedure to bridge and support the site of repair and help drain the kidney. This stent is kept in place for approximately 4 weeks and is usually removed in the doctor's office. Immediately after the surgery, a small drain will also be left exiting your flank to drain away any fluid around the kidney and pyeloplasty repair.

What are the potential risks and complications?

Although the safety and efficacy of this procedure has been well established for selected patients, as with any surgical procedure, there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:
  • Bleeding: Blood loss during this operation is typically minor (average of 100ml) and need for blood transfusion is observed in less than 5% of the patients. 
  • Infection: In order to decrease the chance of infection after surgery, all patients are treated with intravenous antibiotics prior to the surgery. If you develop any signs or symptoms of infection after the surgery {fever (>100.5o F) drainage from incision, urinary frequency/discomfort, pain or anything that you may be concerned about, please inform your doctor immediately.
  • Tissue / Organ Injury: Although uncommon, possible injury to the surrounding tissue and organs including bowel, lung, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery.
  • Conversion to Open Surgery: The surgical procedure may require conversion to the standard open operation. The conversion to open surgery should not be considered as a failure of the procedure but it is a sound surgical decision made by the operating surgeon to complete the challenging procedure safely and effectively without compromising the results. This could result in a larger than standard open incision and possibly a longer recuperation period.
  • Failure to correct UPJ obstruction: Roughly 3 % of patients undergoing this operation may get persistent blockage due to recurrent scarring. If this occurs additional surgery may be necessary.

What to expect immediately after the surgery

Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.
  • Post Operative Pain: Pain medications are used to control the pain associated with the incision after the surgery. Pain medication can either be controlled and delivered by the patient or administered by the nursing staff via an intravenous catheter. You may also experience some minor transient shoulder pain (1-2 days) related to the gas used to inflate your abdomen during the laparoscopic surgery. Most patients see a large improvement in their pain level on the second day after surgery.
  • Nausea: You may experience some nausea related to the anesthesia. Medications are given to treat nausea.
  • Urinary Catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room prior to surgery) for approximately one to two days after the surgery.
  • Drain: You will have a small tube coming out of the abdomen which drains blood tinged liquid. It prevents blood or fluid from collecting up around the kidney and site of repair. The drain is removed as soon as it becomes less than a specified limit.
  • Diet: You can expect to have an intravenous catheter (IV) in for 1-2 days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated; in addition it provides a way to receive medication.). Following surgery, the bowels will transiently “go to sleep”. Most patients are able to tolerate ice chips and then clear liquids the day after surgery. The diet is then advanced as tolerated by the patient. Once on a regular diet, pain medication will be taken by mouth instead of by IV or shot.
  • Fatigue: Fatigue is common after the surgery. This is part of the body’s normal healing process. It should subside within a week time following the surgery.
  • Incentive Spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you during your hospital stay). Coughing and deep breathing is an important part of your recuperation and help prevent pneumonia and other pulmonary complications.
  • Ambulation: On the day after surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can expect to have SCD’s (sequential compression devices) along with tight white stockings on your legs to prevent blood clots from forming in your legs.
  • Hospital Stay: The length of hospital stay for most patients is for approximately 1-2 days.
  • Constipation: You may experience sluggish bowels for several days or several weeks. This is a combination of the surgery as well as the narcotic pain medicines. Suppositories and stool softeners are usually given to help with this problem. Taking stool softeners and mineral oil daily at home will also help to prevent constipation.

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