Category: Laparoscopic/ Robotic: Renal
Introduction & Objective : We present our technique for pyeloplasty using the 5 mm Jaimy robotic needle driver. The case is an 18 year old man that consulted with right lumbar pain. After an IVP a right sided UPJ obstruction was diagnosed. A 2 cm right pelvic stone was also noted, henceforth, a laparoscopic Anderson- Hynes right pyeloplasty was scheduled.
Methods : We placed the patient in a standard left lateral decubitus position. A 10 mm camera port was placed in the umbilicus. Three more 5 mm working ports were placed in a standard fashion. A fourth 5mm port was placed in the mid line for liver retraction. After identification and excision of the UPJ obstruction we proceeded to remove the Stone through a 10mm trocar incision. At this point we use the Jaimy 5 mm robotic needle driver. The flexibility and rotation features of the needle driver mimics the movement of the surgeons hands in the way other robotic systems do. This facilitates suture placement and improves OR times. We use 3.0 interrupted vicryl sutures for the pyeloplasty and place a 7 fr pigtail stent in a retrograde fashion. We place stitches in the base and apex of the ureter and then the pelvis to approximate the tissue. We place 2 stitches on the anterior and posterior plate
Results : The total OR time was 150 minutes. No transoperative complications were observed. The patient was discharged on postoperative day 2 and the ureteral stent was retrieved 1 month postoperatively. No complications or fistulas were reported. Six months after surgery the patient remains asymptomatic with no signs of restenosis. A MAG 3 renography demonstrated an unobstructed well functioning kidney.
Conclusions : The Jaimy 5 mm robotic needle driver is an excellent tool that provides the surgeon with flexibility and maneuverability that other robotic systems do. It greatly facilitates intracorporeal suturing and has drastically improved OR times. The Jaimy robotic needle driver is a viable option for institutions that practice laparoscopic pyeloplasties routinely but lack other robotic system because of their cost.
Mario Gonzalez– @CHAIR, Urology department, San Jose, San Jose, Costa Rica
San Jose, San Jose, Costa Rica
Dr. Mario Gonzalez MD, Chair of Urology Department Hospital La California, San José, Costa Rica
University of Medical Sciences, Costa Ríca
Professor of Urology at University of Costa Rica
Past residency in urology program coordinator for University of Costa Rica
Fellow in Laparoscopy and minimally invasive urologic surgery in Hospital La Floresta, Caracas, Venezuela