What Is Robotic Assisted Pyeloplasty?

A pyeloplasty is a surgical procedure for removing blockage between a kidney and the ureter, which is a small, muscular tube that transports urine from the kidney to the bladder. The medical name for this blockage is a ureteropelvic junction obstruction or UPJ obstruction. Blockage of urine flow from the kidneys can result in critical health issues, including back or abdominal pain, kidney stones, high blood pressure, infections, and renal failure.

A robotic assisted pyeloplasty is a minimally invasive alternative to open, large-incision surgery. It has several advantages over the traditional method, including decreased blood loss, less post-operative discomfort, and shorter recovery times.

Baptist Health is a regional leader in using advanced surgical technology for urological conditions. ??Robot-assisted pyeloplasty is performed at several of our facilities in Kentucky and Indiana??.

At What Age Can You Get Robotic Assisted Pyeloplasty?

Some persons are born with a UPJ obstruction. Infants with this condition typically require surgery within 18 months of birth, though some procedures are performed earlier, before the patient’s first birthday. Renal obstructions can also develop over time in older children, adolescents, and adults. The backing up of urine often results in swollen kidneys, which can be diagnosed by means of imaging technology.

Benefits of Robotic Assisted Pyeloplasty Over Traditional Surgery

A robotic procedure does not mean being operated on by a mechanical man rather than a human being. Robotic procedures are robot-assisted procedures, where the robot is a group of tools used by a surgeon and his or her medical team to aid in an operation. These tools are called robots because they mimic human motions and movements, sometimes with greater precision and less fatigue than we’re capable of.

Robotic surgery offers the following benefits:

• Smaller incisions than with open surgery, and therefore less blood loss
• Reduced scarring
• Lower risk of infection
• Decreased post-surgical pain
• Shorter hospital stays
• Quicker recovery times
• Faster return to normal living

Although robotic surgery is beneficial for many patients, it is not without risks. Any surgery, open, endoscopic, laparoscopic, or robotic, carries with it the possibility of infection, internal bleeding, organ damage, and adverse reactions to anesthesia. In numerous cases, however, these risks are lower with robot-assisted surgery.

How Does a Robotic Assisted Pyeloplasty Work?

At Baptist Health, robot-assisted pyeloplasties are performed with the aid of the Intuitive da Vinci system. Intuitive is a leading American manufacturer of medical robots and related equipment.

The Intuitive da Vinci system has three parts:

• a multi-armed robot for making incisions and inserting cameras and other surgical instruments in the patient;
• a vision cart with endoscopic monitors that provide the surgeon with magnified, three-dimensional, real-time images of the surgical site within the body;
• a computerized panel from which the surgeon controls the robot and performs the procedure.

A robotic pyeloplasty is conducted similarly to laparoscopic and other forms of minimally invasive surgery. The robot makes tiny incisions for the insertion of a camera – the surgeon’s eyes during the procedure – and other operating instruments for removing the obstruction and reattaching the kidney and ureter. However, a robot-assisted procedure has the advantage of greater precision than a human operating alone because robot technology downscales the surgeon’s hand motions to extremely fine movements, reducing the possibility of organ or tissue damage.

Joining the surgeon and the robot in the operating theater are the entire surgical team, including the anesthesiologist, the nurses, and a second surgeon or surgical assistant for moving the robot into positions that aren’t mechanically controlled.

What to Expect

Your medical team will provide instructions on preparing for surgery. You’ll likely fast for at least eight hours prior to the procedure. Your physician will also advise you on taking your regular medications beforehand. Arrange to have someone drive you home from the hospital, after your release.

A robot-assisted pyeloplasty involves several steps. Your surgical team will:

• Administer a general anesthetic, so that you sleep through the procedure.
• Place you on your side on the operating table.
• Make four or five small incisions close to your affected kidney through which the camera and other surgical tools will be inserted.
• Cut away and extract the blocked portion of your ureter.
• Reattach the ureter to your kidney’s renal pelvis, which serves as the collection point for urine before movement to the bladder.
• Insert a small tube or stent to facilitate urine drainage while the reattached tissues heal.
• Close the incisions.

You’ll be moved from the surgical suite to a recovery area and then to a hospital room. Most patients stay a day or two on site before going home.

How Long Does a Robotic Assisted Pyeloplasty Take?

A procedure of this type typically takes from two to four hours. The length of time depends on your overall medical condition and other individual circumstances.

Recovery Process

The recovery process from a robot-assisted procedure can take a couple of weeks. You may experience some pain, though less than if you had undergone an open procedure. You may also see some blood in your urine.

Your provider will schedule a pair of follow-up appointments. The first will be to remove your stent, which is no longer needed once the reattached tissues have healed. This can be done in a physician’s office. The second will be for an ultrasound, to confirm that improved urine flow has reduced kidney inflammation.

What to Avoid After Robotic Assisted Pyeloplasty?

You should forgo lifting heavy objects or undertaking strenuous exercise for a month or more following a pyeloplasty procedure. Limit your bathing to showers, to reduce the chance of infection.

Potential Risks and Complications

Medical data show that pyeloplasty is an effective procedure for improving urine flow from the kidneys to the bladder. There remains, however, some risk of complication, even with minimally invasive procedures. Of potential concern are:

• Blood loss
• Damage to blood vessels
• Herniation
• Infection
• Negative reactions to anesthesia
• Scarring
• Urine leakage at the reattachment point

Finding a Specialist

A robotic assisted pyeloplasty is a proven procedure for removing an obstacle to urine flow at the point where kidney and ureter meet. As a minimally invasive form of surgery, robot-assisted procedures have several advantages over traditional open surgery. Baptist Health is committed to being a leading medical provider of robot-assisted diagnosis and surgery in Kentucky and Southern Indiana. If you have questions or concerns about your kidney, bladder, or urological health, contact one of our specialists.

Call to schedule a consultation today!