BACKGROUND: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years.
OBJECTIVE: To report a stage 2a study of robot-assisted single-site (R-LESS) pyeloplasty for ureteropelvic junction obstruction (UPJO).
DESIGN, SETTING, AND PARTICIPANTS: This study is an investigative pilot study of 30 consecutive cases of R-LESS pyeloplasty performed at two participating institutions between July 2011 and September 2013.
SURGICAL PROCEDURE: Dismembered R-LESS pyeloplasty was performed at two surgical centers.
MEASUREMENTS: Feasibility (conversion rate), safety (complication rate and Clavien-Dindo classification), efficacy (clinical outcome) of the procedure were assessed.
RESULTS AND LIMITATIONS: The median patient age was 37 yr (range: 19-65 yr) and median body mass index was 23kg/m2 (range: 19-29kg/m2). The median operative time was 160min (range: 101-300min), the median postoperative stay was 5 d (range: 3-13 d), and the median time to catheter removal was 3 d (range: 2-10). Two cases required conversion, the first one to standard laparoscopic technique and the second one to standard robotic technique. No intraoperative complications were reported. In three cases, an additional 5-mm trocar was needed. The postoperative complications rate was 26% (n=8). Most of them were grade 1 complications (n=4; 13%), followed by grade 2 (n=3; 10%) and grade 3 (n=1; 3.3%) complications, according to the Clavien-Dindo classification. One patient needed a surgical reintervention with standard robotic technique 3 d after surgery for urinary leakage. The overall success rate, considered as the resolution of symptoms and the absence of functional impairment at postoperative imaging, was 93.3% (n=28) at a median follow-up of 13 mo (range: 3-21 mo). The main limitations of this study are the limited number of patients included and the short-term follow-up.
CONCLUSIONS: Single-site robotic pyeloplasty is a feasible technique in selected patients, with good cosmetic results and excellent short-term clinical outcomes. Prospective studies are needed to further assess its role for the treatment of UPJO.
PATIENT SUMMARY: Single-site robot-assisted pyeloplasty is a feasible technique with good cosmetic results and excellent short-term clinical outcomes.
Written by:
Buffi NM, Lughezzani G, Fossati N, Lazzeri M, Guazzoni G, Lista G, Larcher A, Abrate A, Fiori C, Cestari A, Porpiglia F. Are you the author?
Department of Urology, San Raffaele Turro Hospital, Milan, Italy; Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; Department of Urology, Istituto Auxologico Italiano, Milan, Italy.
Reference: Eur Urol. 2014 Mar 13. pii: S0302-2838(14)00210-3.
doi: 10.1016/j.eururo.2014.03.001
PubMed Abstract
PMID: 24656756
UroToday.com Adrenal and Kidney Conditions Section
