Presented by: Leon Chertin MD
Shamir Medical Center

Introduction

To evaluate surgical outcomes of  Robotic Assisted Laparoscopic dismembered pyeloplasty (RALP) with UPJ repositioning as a modified technique during which the UPJ is brought to a new location to ease with the anastomosis.

Materials

We have performed a retrospective review of all RALP cases performed between the years 2016-2022 at our department. In a selected group of patients repositioning of the UPJ was performed. In brief, the original junction was suture ligated, the spatulated ureter was anatomized end to side to the most dependent and accessible part of the renal pelvis. Performing repositioning was determined by the surgeon during the procedure. We have compared the demographic data, surgical and post-surgical outcomes to a group that underwent classical A.H dismembered pyeloplasty.

Results

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Overall, 70 patients underwent robotic assisted laparoscopic dismembered pyeloplasty and were included in the study, 15 in the repositioning group and 55 in the A.H group. Median age was 26 month (IQR 7-150) and median operative time was 140 minutes (IQR 129-192) and 170 (IQR 135-207) in the repositioning and A.H group respectively. The cause for UPJ repositioning was: crossing vessel (n=5), high UPJ insertion (n=8), renal malformation (horse shoe, double collecting system, n=2).  There was no difference between the groups regarding follow up, AP diameter, UTD classification SFU classification, split renal function and diuretic T1/2 pre and postoperatively. Post operatively both groups showed improvement in AP diameter and diuretic T1/2 (P=0.48). There was 1 case of failure requiring redo-surgery in the repositioning group (6.6%) and 3 in the AH groups (5.5%), (P>0.05). Overall, there were 3 cases of Clavien-Dindo grade 3 complications, all in the AH group (2 cases of urine leak from anastomosis, one case of port side hernia).

Conclusion

Repositioning of the UPJ is optional in cases when the obstructed UPJ is in a non-optimal anatomical position. This simple modification does not negatively effect complications or surgical outcomes and may be added to the armamentarium of RALP.

Funding

None

Co-Authors

Avigal Lask,
Shamir Medical Center

Omri Schwarztuch Gildor,
Meir Medical Center

Amnon Zisman,
Shamir Medical Center

Amos Neheman,
Meir Medical Center