Category: Robotic Surgery: Upper Tract - Benign

VS16-1 - A Novel Technique for Robotic Pyeloplasty: Offset Apical Sutures

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective : Various methods exist for reconstruction of ureteral pelvic junction obstructions. Often the most difficult aspect of the surgery is placing the apical sutures, which are vital to the success of the operation. We present the technique used at our institution for a dismembered pyeloplasty which is a variation of the Van-Velthoven technique.


Methods :

We reflect the bowel medially and then fully mobilization of the renal pelvis and proximal ureter. The renal pelvis is incised proximal to the obstruction to create a handle out of the redundant renal pelvis. The sutures are placed offset from the apex of the spatulated ureter and the posterior wall suture is run first. 


Results :

This technique results in a technically simpler anastomosis with a dependent, funnel shaped ureteral pelvic junction. 


Conclusions :

This technique allows the surgeon to better visualize the apex and place the critical sutures with improved precision. This prevents back-walling of the sutures and ensures the lumen is not narrowed at the anastomotic site. The use of the renal pelvis handle allows for a no-touch technique, which preserves blood supple to the tissues.

Luke F. Reynolds

Clinical Fellow
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada

R John D'A.. Honey

Professor
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada

Michael Ordon

Associate Professor
St. Michael's Hospital - University of Toronto
Toronto, Ontario, Canada