Category: Laparoscopy: Upper Tract - Benign
Introduction & Objective : Uretero-pelvic junction obstruction (UPJO) is a common condition and most of patients in developing countries present in adulthood. Management options vary; ranging from the standard dismembered pyeloplasty to complex procedures like calycouereterostomy , pyelovesicostomy and boari flap calycovesicostomy. Management of failed surgical repair is all the more challenging with a significant number being managed by open surgery. The advent of robotic surgery has opened up new dimensions in easily performing complex reconstructive surgeries with minimal morbidity.
A 28 year old lady who had undergone open pyeloplasty for right sided UPJO and subsequently robot assisted calycoureterostomy 2 years later for anastomotic stricture presented to the outpatient department of our hospital with right sided flank pain and fever. She was found to have obstructed drainage with a differential function of 29% for the right kidney on renogram. The patient was managed conservatively with double J (DJ) stent placement and iv antibiotics. Due to persistent symptoms, a percutaneous nephrostomy (PCN) was inserted on the right side which drained 1500ml of urine per day. She was further evaluated with a CT urography which revealed a gross hydronephrosis in the right kidney with PCN in situ.
: Patient was planned for surgical intervention in the form of robot assisted Boari flap calycovesicostomy using Da Vinci SI system. The patient was placed in supine position and ports placed in standard fashion. The ascending colon was mobilised medially and the lower pole of the hydronephrotic right kidney was dissected and hitched to the psoas tendon. The inferior calyx was dissected and a calycostomy created. Urinary bladder was filled with saline and Boari Flap was raised from bladder dome and anterior wall. The flap was mobilised to the calycostomy and posterior layer of calycovesicostomy completed using vicryl 3-0 continuous suture. The suprapubic (18 Fr Foley) catheter (SPC) was passed through the calycovesicostomy, using it as a splint to tubularize the flap. A 6 Fr silicon DJ stent was also inserted through the anastomosis. The calycovesicostomy tubularized over the 18 Fr foley catheter was completed and the bladder was closed using vicryl 2-0 in a continuous fashion. A 24 Fr drain was placed after ensuring a water-tight anastomosis. The patient is doing well 1 month post-surgery and voiding well.
: Robot assisted Boari Flap calycovesicostomy is a safe and feasible procedure for patients with previous failed surgeries and provides a wide gravity dependent drainage for the kidney with minimal morbidity and good outcomes.
Professor of urology
Chandigarh, Chandigarh, India
As a professor of urology at a one of the most premier institute ie. PGIMER, Chandigarh • i published 160 article in international journal of repute ie PUBMED indexed.
Contributed significantly in theGenito-Urinary Carcinoma , stones, reconstructive and laparoscopic and Robotic surgical cases . New surgical techniques developed by me to simplify the surgery, reduce the blood loss in surgery, decrease hospital stay and operative duration.
• Actively involved in regular bed-sides teaching of junior and senior residents as a consultant.
• Regularly coordinating interdepartmental academics meets of radiotherapy and urology case related to management of genitourinary cancers.
• Regularly coordinating interdepartmental academics meets of urology and radiotherapy case related to management of genitourinary cancers, urology and nephrology clinical rounds, urology and radiology rounds..
Developed many new surgical techniques
• Teaching of both the MS (General surgery) and MCh (Urology ) residents by the way of taking teaching rounds, decision making, seminars and bed-side classes in both routine and emergency wards
• Teaching of residents of other disciplines like Radiology, Gynae & Obstetrics
• Teaching of ‘visitor residents’ from other institutions from other places coming to our hospital for training
• Teaching residents regarding publication and presenting in national and international conferences