Category: Robotic Surgery: Upper Tract - Benign

VS8-12 - Robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction with duplex systems

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

The use of robotic assistance in urologic laparoscopic surgery has expanded exponentially in recent years, given the unique features provided by the robotic platform, especially in the setting of reconstructive procedures where extensive suturing is necessary. 

Methods :

We showed our experience of robot-assisted laparoscopic pyeloplasty in the patient presented with repeated urinary tract infections (UTIs) due to duplex systems and ureteropelvic junction obstruction (UPJ).

Results :

A 21-year-old female presented with repeated UTIs for 1 year. An ultrasound scan and CT scan revealed hydronephrosis of the left kidney. Retrograde pyelography showed left a partial duplex system with upper calyx as upper moiety and mid/lower calyx as a lower moiety. UPJO was confirmed in the ureter originated from the lower moiety of the two systems. Port placements were similar to standard robot-assisted pyeloplasty with using a camera, two robotic arms and an additional 10 mm port for an assistant. A Toldt line was incised, and ascending colon was mobilized. The Gerota's fascia was incised longitudinally, and psoas muscle was identified. The ureter was identified by peristaltic movements and traced till UPJ. The renal pelvis was dissected, and the duplex system was identified. The pelvis of the lower moiety was dilated with narrowing at the UPJ. The renal pelvis of the lower moiety was incised and extended beyond the UPJ into the common ureter. The narrowed UPJ segment of the lower moiety was divided, and the common ureter was spatulated. End to side anastomosis was performed with 4-0 monocryl running fashion. A double-J stent (DJS) was introduced across the anastomosis into both the bladder and the upper moiety.  Total operative time was 277 minutes and blood loss was 17ml. The postoperative course was uneventful. She discharged on postoperative day 7. DJS was removed at 6 weeks later from the operation. On Follow-up, the patient has been fever-free since the surgery.

Conclusions : Duplex system with lower moiety UPJO is a rare entity and technically challenging for reconstruction. Robot-assisted laparoscopic pyeloplasty in the duplex system is a safe and feasible option.

Kazuyuki Numakura

Assistant Professor
Akita University Graduate School
Akita city, Akita, Japan


2006 Ph. D. (Doctor of Medicine) in Urology
Department of Urology and Renal Transplant Surgery
Akita University School of Medicine, Akita, Japan

Current Research
-Analysis of genetic contribution to renal cell carcinoma

2001 M.D. Akita University School of Medicine, Akita, Japan


2018-present Assistant Professor, Department of Urology, Akita University Graduate School of Medicine
2012-2018 Lecturer, Department of Urology, Akita University Graduate School of Medicine
2009-2012 Assistant, Department of Urology, Akita University Graduate School of Medicine
2008-2009 The Head of Urological Department, Fujiwara Memorial Hospital
2007-2008 The Head of Urological Department, Yokote Municipal Hospital
2006-2007 The chief of Urological Department, Iwate Prefectual Isawa Hospital
2005-2006 Senior resident, Department of Urology, Toranomon Hospital
2001-2005 Resident/Senior Resident, Department of Urology, Akita University School of Medicine


2001 Medical Doctor’s Licence, Japan (No. 422401)

Taketoshi Nara

Urology/Akita University School of Medicine
Akita City, Akita, Japan

Syuji Chiba

Akita city, Akita, Japan

Sohei Kanda

Akita University graduated School of Medicine
Akita City, Akita, Japan

Sohei kanda
Speciality : laparoscopic surgery, urogenital cancer

Migguo Huang

Akita, Akita, Japan

Mitsuru Saito

Akita city, Akita, Japan

Shintaro Narita

Akita city, Akita, Japan

Takamitsu Inoue

Akita City, Akita, Japan

Shigeru Satoh

Akita City, Akita, Japan

Tomonori Habuchi

Akita City, Akita, Japan