Robotic Assisted Laparoscopic Pyeloplasty

Learn more about robotic assisted laparoscopic pyeloplasty at King Edward VII’s Hospital

Why would I need robotic assisted laparoscopic pyeloplasty?

UPJ obstruction is a condition where a blockage occurs when urine is leaving the kidney to the bladder via the ureter. The blockage causes pressure to build up inside the renal pelvis and kidney causing pain, kidney stones and sometimes a decline in kidney function.

What symptoms does robotic assisted laparoscopic pyeloplasty address?

Most people are born with UPJ obstruction, but it can develop over time due to trauma, scar tissue, ureteral valves, a crossing blood vessel or tumour.

The procedure removes the obstruction, thereby alleviating the pressure build up and removing the cause of pain.

When should you speak to your specialist about robotic assisted laparoscopic pyeloplasty?

If you are experiencing any of the above symptoms speak to one of our specialist about treatment options.

How is robotic assisted laparoscopic pyeloplasty performed?

Robotic pyeloplasty is a laparoscopic technique, which means very small incisions (keyhole incisions) are made and the procedure is performed using a robot.

Through these very small incisions robotic instruments perform a repair, directed by a surgeon.

Details of the procedure:

• We use a full general anaesthetic and you will be asleep throughout the procedure
• We usually give you an injection of antibiotics before the procedure, after you have been checked for any allergies
• We normally put a catheter into your bladder, during the operation, to measure urine output. Your urologist can tell you whether this is likely to be needed
• We inflate your abdominal cavity with carbon dioxide gas
• The operation is performed through several “keyhole” incisions through which robotic instruments are placed into the abdominal cavity
• We divide or cut away the narrowing at the pelviureteric junction; we may need to fold down a flap of tissue from the kidney to widen the narrowing
• We normally put a stent in your ureter to speed up healing
• We usually put a drain close to the kidney to collect any fluid which forms around the surgical site; the drain is normally removed the following day
• You will be given fluids to drink immediately after the operation and we will encourage you to move as soon as you are comfortable (to help prevent blood clots forming in your legs)
• Your wound drain and catheter are normally removed after 24 to 48 hours
• The average hospital stay is between one and two days

What is the recovery like for robotic assisted laparoscopic pyeloplasty?

Your recovery will depend on multiple factors, including your age, fitness level and the nature of your procedure.

You will usually stay in hospital for one day and your drain will be removed before returning home.

You may experience some discomfort and nausea a few days after the surgery. Your intestinal function may be a little slow after surgery, so a small liquid diet is recommended until you pass gas and your appetite returns. This usually only lasts a day.

It is recommended to avoid heavy lifting or exertion for up to 4 weeks following surgery, although gentle exercise such as walking is encouraged. Most people can return to full activity, including work, after 1-2 weeks.

Are there any risks/complications associated with robotic assisted laparoscopic pyeloplasty?

As with any major medical procedure, it’s possible for risks or complications to arise although these are rare with robotic assisted laparoscopic pyeloplasty.

• Shoulder tip pain due to irritation of your diaphragm by the carbon dioxide gas
• Temporary abdominal bloating (gaseous distension)
• A further procedure to remove the stent in your ureter, usually under local anaesthetic
• Bleeding, infection, pain or hernia in one (or more) of the port sites, requiring further treatment
• Continuing pain, even when the post- operative scans show that your kidney drainage has improved
• Recurrent narrowing or scarring requiring further surgery
• Bleeding needing conversion to open surgery or requiring blood transfusion
• Recognised (or unrecognised) injury to nearby local structures (blood vessels, spleen, liver, kidney, lung, pancreas, bowel) requiring more extensive surgery
• Need to remove the kidney at a later stage because of damage caused by recurrent blockage

How can I prepare for robotic assisted laparoscopic pyeloplasty?

Prior to surgery, your surgeon will discuss with you how best to prepare, as each patient is different with differing needs.

Common preparations include:

• Routine blood tests, x rays or scans as requested by your surgeon
• Taking steps to stop smoking if you smoke
• Losing weight if you’re overweight
• Remaining active and doing regular exercise

Are there alternatives for robotic assisted laparoscopic pyeloplasty?

• Observation – this may be an option when symptoms are minor and not felt to justify surgery
• Telescopic incision (endopyelotomy) – cutting open the narrowed area with an electric wire passed up from the bladder or through the skin over the kidney
• Stretching of the area of narrowing – using a balloon passed up from the bladder or through the skin over the kidney, under X-ray screening
• Temporary stenting – by placing a small plastic tube (stent) through the narrowed area
• Open surgery (pyeloplasty) – reconstruction of the narrowed area through an incision in your loin

Your consultant will go over all treatment options, including robotic assisted laparoscopic pyeloplasty.