Robot-assisted laparoscopic surgery in the management of complex hydronephrosis:single-center early experience
Xuan Yundong
Du Qingshan
Yu Fei
Zhang Xu
Ma Xin
Fan Yang
Abstract：Objective:To report early single-center retrospective case series of outcomes after robot-assisted lap-aroscopic surgery in patients with complex hydronephrosis.Methods:The clinical data of 20 patients with complicat-ed hydronephrosis who underwent robotic-assisted laparoscopic surgery admitted to the Third Medical Center of PLA General Hospital from January 2023 to June 2023 were collected statistically and analyzed retrospectively.Complex hydronephrosis was defined as hydronephrosis that could not be resolved by Anderson-Hynes pyeloplasty,ureteroure-terostomy or ureteroneocystostomy.And the causes of obstruction included restenosis after pyeloplasty,long-seg-ment ureteral stenosis after endoscopic surgery(>2 cm),long-segment ureteral polyp(>2 cm),pyelo-ureteral junc-tion obstruction(UPJO)combined with multiple renal calculi,and UPJO combined with horseshoe kidney,etc.Sur-gical success was defined as the disappearance or relief of symptoms and imaging studies suggesting that the hydrone-phrosis was relieved compared with before.Results:All 20 patients were operated under robotic-assisted laparosco-py,with no intraoperative complication and no conversion to open surgery intraoperatively,including 8 cases of robot-ic dismembered pyeloplasty,4 cases of robotic Boari bladder flap ureteral reconstruction,3 cases of robotic appendi-ceal onlay ureteroplasty,2 cases of robotic dismembered for horseshoe kidney plus pyeloplasty,1 case of robotic lin-gual mucosal graft ureteroplasty,1 case of robotic colonic onlay ureteroplasty,and one case of robotic ureteroureter-ostomy between transplanted ureter and autologous ureter.The average operating time was 222.5(185.8-313.0)min,the median intraoperative blood loss was 50(50-100)ml,the average postoperative hospitalization was 5(4-5)d,and the average postoperative drain was left in place for 3(2.0-3.8)d.The incidence of postoperative Clavien's class Ⅰ-Ⅱ was 10％,and the anastomotic leakage was observed in 2 cases,which was resolved spontaneously after the exten-sion of drain placement(9 days and 2 days respectively).The median follow-up was 5.2(3.0-8.5)months,and the surgical success rate was 95％(19/20).Conclusion:Robotic-assisted laparoscopic surgery is safe and feasible for the treatment of complex hydronephrosis,with favorable early results.The development of surgical strategies according to the causes of obstruction(secondary stenosis,long ureteral stenosis)and the development of intraoperative coun-termeasures(flap technique,tissue replacement)are the keys to improve the success rate of the surgeries.
Keywords：robotic surgerycomplex hydronephrosisureteral stenosis
Publication Date：2024-10-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 343-349 )