Robot-assisted Laparoscopic Pyeloplasty in Adults: A Comparison Analysis of Primary versus Redo Pyeloplasty in a Single Center
5 January 2019
Purpose: Approximately 10% of all primary pyeloplasty will require at least one secondary intervention. Our aim was to analyze whether secondary repair will pose additional challenges during robotic pyeloplasty compared with the primary pyeloplasty.
Material and Methods: 114 patients who underwent robot-assisted laparoscopic pyeloplasty (RALP) between February 2015 and August 2018 were retrospectively reviewed. Patients were divided into; primary and secondary repair pyeloplasty. The demographics, intraoperative parameters, postoperative parameters, and success rate of these two groups were collected and compared. Primary RALP data were further stratified into those who previously underwent ipsilateral endourological surgeries (IES) at the obstruction site and those who did not, to evaluate the effect of IES has on the outcome of RALP. Success was defined as symptomatic and radiological relief.
Results: Of the 114 patients, five complicated cases (three horseshoe kidneys, one duplicated system, and one retrocaval ureter) were excluded from the comparison. The remaining 96 primary and 13 secondary repairs were compared. Intraoperative and postoperative parameters showed no significant difference between the two groups. The results of 99 patients (87 vs. 12 in primary vs. secondary, respectively) were available after 27.5 months mean follow-up. The overall success was 92%, 8 patients failed (5 vs. 3 in primary vs. secondary, respectively) and required further surgical interventions.
Conclusion: Though surgically challenging with increased recurrence rates according to the literature we reviewed. However, our data failed to show any significant difference between the primary and redo RALP perhaps due to the smaller size in the redo RALP group.
- primary pyeloplasty; secondary pyeloplasty, robot-assisted laparoscopy; comparison, outcomes
How to Cite
Bansal P, Gupta A, Mongha R, Narayan S, Das RK, Bera M, et al. Laparoscopic versus open pyeloplasty: comparison of two surgical approaches- a single centre experience of three years. Indian J Surg. 2011;73(4):264-7.
Dy GW, Hsi RS, Holt SK, Lendvay TS, Gore JL, Harper JD. National Trends in Secondary Procedures Following Pediatric Pyeloplasty. J Urol. 2016;195(4 Pt 2):1209-14.
Elmussareh M, Traxer O, Somani BK, Biyani CS. Laser Endopyelotomy in the Management of Pelviureteric Junction Obstruction in Adults: A Systematic Review of the Literature. Urology. 2017;107:11-22.
Corbett HJ, Mullassery D. Outcomes of endopyelotomy for pelviureteric junction obstruction in the paediatric population: A systematic review. J Pediatr Urol. 2015;11(6):328-36.
Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, et al. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol. 2014;65(2):430-52.
Cestari A, Buffi NM, List
a G, Sangalli M, Scapaticci E, Fabbri F, et al. Retroperitoneal and transperitoneal robot-assisted pyeloplasty in adults: techniques and results. Eur Urol. 2010;58(5):711-8.
Atug F, Burgess SV, Castle EP, Thomas R. Role of robotics in the management of secondary ureteropelvic junction obstruction. Int J Clin Pract. 2006;60(1):9-11.
Mufarrij PW, Woods M, Shah OD, Palese MA, Berger AD, Thomas R, et al. Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol. 2008;180(4):1391-6.
Niver BE, Agalliu I, Bareket R, Mufarrij P, Shah O, Stifelman MD. Analysis of robotic-assisted laparoscopic pyleloplasty for primary versus secondary repair in 119 consecutive cases. Urology. 2012;79(3):689-94.
Sivaraman A, Leveillee RJ, Patel MB, Chauhan S, Bracho JE, 2nd, Moore CR, et al. Robot-assisted laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: a multi-institutional experience. Urology. 2012;79(2):351-5.
Thom MR, Haseebuddin M, Roytman TM, Benway BM, Bhayani SB, Figenshau RS. Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience. Int Braz J Urol. 2012;38(1):77-83.
Baek M, Silay MS, Au JK, Huang GO, Elizondo RA, Puttmann K, et al. Quantifying the Additional Difficulty of Pediatric Robot-Assisted Laparoscopic Re-Do Pyeloplasty: A Comparison of Primary and Re-Do Procedures. J Laparoendosc Adv Surg Tech A. 2018;28(5):610-6.
Abdel-Karim AM, Fahmy A, Moussa A, Rashad H, Elbadry M, Badawy H, et al. Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children. J Pediatr Urol. 2016;12(6):401 e1- e6.
Badlani G, Eshghi M, Smith AD. Percutaneous surgery for ureteropelvic junction obstruction (endopyelotomy): technique and early results. J Urol. 1986;135(1):26-8.
Patel T, Kellner CP, Katsumi H, Gupta M. Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction. J Endourol. 2011;25(4):587-91.
Leavitt DA, Nicholson AF, Ortiz-Alvarado O, Maust TJ, Rutledge GM, Walker SP, et al. Nature of crossing vessels in patients with radiographically normal ureteropelvic junctions: prevalence and anatomic characteristics. Urology. 2013;81(6):1168-72.
Grimsby GM, Jacobs MA, Gargollo PC. Success of Laparoscopic Robot-Assisted Approaches to Ureteropelvic Junction Obstruction Based on Preoperative Renal Function. Journal of endourology. 2015;29(8):874-7.
Alhazmi HH. Redo laparoscopic pyeloplasty among children: A systematic review and meta-analysis. Urol Ann. 2018;10(4):347-53.
Abdrabuh AM, Salih EM, Aboelnasr M, Galal H, El-Emam A, El-Zayat T. Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience. J Pediatr Surg. 2018;53(11):2250-5.
Vannahme M, Mathur S, Davenport K, Timoney AG, Keeley FX, Jr. The management of secondary pelvi-ureteric junction obstruction - a comparison of pyeloplasty and endopyelotomy. BJU Int. 2014;113(1):108-12.
Nishi M, Tsuchida M, Ikeda M, Matsuda D, Iwamura M. Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction: long-term results. Int J Urol. 2015;22(4):368-71.
Criss CN, Ralls MW, Johnson KN, Awtar S, Jarboe MD, Geiger JD. A Novel Intuitively Controlled Articulating Instrument for Reoperative Foregut Surgery: A Case Report. J Laparoendosc Adv Surg Tech A. 2017;27(9):983-6.
Dirie NI, Wang Q, Wang S. Two-Dimensional Versus Three-Dimensional Laparoscopic Systems in Urology: A Systematic Review and Meta-Analysis. J Endourol. 2018;32(9):781-90.
Wang F, Xu Y, Zhong H. Robot-assisted versus laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: an updated systematic review and meta-analysis. Scand J Urol. 2013;47(4):251-64.
Lucas SM, Sundaram CP, Wolf JS, Jr., Leveillee RJ, Bird VG, Aziz M, et al. Factors that impact the outcome of minimally invasive pyeloplasty: results of the Multi-institutional Laparoscopic and Robotic Pyeloplasty Collaborative Group. J Urol. 2012;187(2):522-7.
Hemal AK, Mishra S, Mukharjee S, Suryavanshi M. Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair. Int J Urol. 2008;15(8):744-6.
Rowe CK, Pierce MW, Tecci KC, Houck CS, Mandell J, Retik AB, et al. A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive? J Endourol. 2012;26(7):871-7.
Park S, Kang J, Park EJ, Baik SH, Lee KY. Laparoscopic and Robotic Surgeries for Patients With Colorectal Cancer Who Have Had a Previous Abdominal Surgery. Ann Coloproctol. 2017;33(5):184-91.
Wei X, Lu J, Siddiqui KM, Li F, Zhuang Q, Yang W, et al. Does previous abdominal surgery adversely affect perioperative and oncologic outcomes of laparoscopic radical cystectomy? World J Surg Oncol. 2018;16(1):10.
Abdullah N, Rahbar H, Barod R, Dalela D, Larson J, Johnson M, et al. Multicentre outcomes of robot-assisted partial nephrectomy after major open abdominal surgery. BJU Int. 2016;118(2):298-301.
- Abstract Viewed: 0 times
- Just Accepted/5257 Downloaded: 0 times