Computer-assisted laparoscopic pyeloplasty: University of Miami experience with the daVinci™ surgical system

Purpose: We report our experience with laparoscopic pyeloplasty using the daVinci™ surgical platform. Patients and Methods: We routinely performed laparoscopic pyeloplasties prior to acquiring the daVinci system. We prospectively evaluated 26 computer-assisted laparoscopic pyeloplasties (CLP) performed since acquiring the device in March 2003. There were 15 male and 11 female patients with a mean age of 34.5 years, who underwent right-sided procedures in 11 cases and left-sided procedures in 15 cases. Four patients (15%) had secondary ureteropelvic junction obstruction. All procedures were performed through a transperitoneal approach over stents placed preoperatively. The operative time excluded the time needed for stent insertion. Radiographic objective success was defined as adequate cortical drainage (t_1/2 ≤15 minutes) and preserved or improved renal function on MAG-3 diuretic renography. Results: A total of 23 dismembered pyeloplasties and 3 Y-V plastics were performed. In five patients, nephroscopy was performed for stone removal. The mean operative time and blood loss were 245 minutes and 69 mL, respectively. There were no intraoperative complications or open conversions. Three minor post-operative complications were noted. The mean length of hospital stay was 2 days (range 1-5 days). In 19 evaluable patients, at a median follow-up of 6 months (range 2-10 days), 15 (79%) had complete symptom resolution, while 3 (16%) had marked symptom improvement. The overall subjective improvement rate thus was 95%. The objective success rate based on our strict diuretic renography criteria was 100%. The overall clinical success rate was 95% (18/19). Conclusions: Robot-assisted laparoscopic pyeloplasty is a feasible alternative to laparoscopic or open pyeloplasty with excellent short-term subjective and objective success rates.