Category: Robotic Surgery: Upper Tract - Benign
VS8-12 - Robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction with duplex systems
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- TN
Taketoshi Nara
– Assistant, Urology/Akita University School of Medicine, Akita City, Akita, Japan - SC
Syuji Chiba
– Akita city, Akita, Japan 
Sohei Kanda
– assistant, Akita University graduated School of Medicine, Akita City, Akita, Japan- MH
Migguo Huang
– Akita, Akita, Japan - MS
Mitsuru Saito
– Akita city, Akita, Japan - SN
Shintaro Narita
– Akita city, Akita, Japan 
Takamitsu Inoue
– Akita City, Akita, Japan- SS
Shigeru Satoh
– Akita City, Akita, Japan - TH
Tomonori Habuchi
– Akita City, Akita, Japan