Robotic Pyeloplasty

What is a robotic pyeloplasty?

Robotic pyeloplasty is a surgery that is done to fix a blockage (obstruction) where the kidney connects to the ureter. This area is called the ureteropelvic junction (UPJ).

You have 2 kidneys. They are each about the size of a fist. Urine made in the kidney goes into a funnel-shaped area called the renal pelvis. From there it goes into a tube called a ureter. The 2 ureters take urine from the kidneys to the bladder.

If urine flow is slowed or stopped between the renal pelvis and the ureter, it builds up in the kidney. This is called a UPJ obstruction. This can cause pain and infection. It can also cause kidney stones and kidney damage.

Pyeloplasty is surgery to fix the blockage so that urine can flow normally. Robotic pyeloplasty is a type of minimally invasive procedure. Minimally invasive means that it uses smaller cuts (incisions) than traditional surgery. Recovery may be easier and faster.

For this procedure, the surgeon uses robotic arms to fix the blockage. These robotic arms have tiny surgical tools attached. The surgeon puts these tools and a tiny video camera through the small incisions. During the surgery, the surgeon sits at a nearby computer. They can see a highly magnified image of the surgical area on the computer screen. Using the computer, they control the robotic tools in real time.

Why might I need a robotic pyeloplasty?

Robotic pyeloplasty may be done if you have a UPJ obstruction. Symptoms of this include:

• Back pain

• Pain on 1 side between your belly and your back

• Blood in your urine

• Kidney infection

• Vomiting

• Urinary tract infection (UTI)

In some cases, babies are born with a UPJ obstruction. Sometimes the condition does not show up until later in life. It can also occur due to an injury, scar tissue, or problems with the ureter.

You will need tests done to confirm you have a UPJ obstruction. These tests will check how well urine is being made and draining out from the kidneys. Tests may include:

• Blood and urine tests

• Nuclear renal scan This test is similar to an IVP, but it uses a radioactive substance instead of dye. The substance can be seen on a camera. The provider can see how well the kidney works and how much blockage is there.

• CT scan with IV contrast

• MRI

• Cystoscopy with retrograde pyelogram

What are the risks of a robotic pyeloplasty?

All procedures have some risks. Some possible risks of this procedure include:

• Bleeding

• Infection

• Kidney pain lasts even after the blockage is removed

• UPJ blockage occurs again

• Urine leakage

• Hernias develop at incision sites

• Injury to nearby organs

• Surgeon has to switch to open surgery due to complications

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a robotic pyeloplasty?

 

• Your healthcare provider will explain the procedure to you. Ask them any questions you have.

• You may need to have some tests before the surgery. These are done to be sure that you are healthy enough to have the procedure. These tests may include:

  • Blood and urine tests to check your general health

  • Chest X-ray to check your lungs

  • EKG (electrocardiogram) to check your heart rhythm

   

 

• You may also have these imaging tests:

  • CT urogram to examine the kidneys, ureters, and bladder

  • Baseline diuretic kidney scan

   

• You may be asked to sign a consent form that gives permission for the surgery. Read the form carefully and ask questions if anything is not clear.

• Tell your provider if you:

  • Are pregnant or think you may be pregnant

  • Are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general)

  • Take any medicines. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.

  • Have had a bleeding disorder

  • Take any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

   

• Make sure to:

  • Stop taking certain medicines before the procedure, if advised by your provider

  • Follow any directions you are given for not eating or drinking before the procedure

  • Follow any other directions your provider gives you

   

Based on your health condition, your healthcare provider may have other instructions.

What happens during a robotic pyeloplasty?

Robotic pyeloplasty requires a hospital stay. The surgery may take 2 to 3 hours. Procedures may vary depending on your condition and your healthcare provider’s practices.

Generally, robotic pyeloplasty follows this process:

1. You will be asked to remove any jewelry or other objects that might get in the way during surgery.

2. You will be asked to remove your clothing and will be given a gown to wear.

3. An IV (intravenous) line will be put in your arm or hand.

4. Before and after the surgery, you may get antibiotics to prevent infection.

5. You will be placed on an operating table.

6. You will be given anesthesia. This will put you into a deep, sleep-like state for the procedure.

7. A thin tube (catheter) will be placed into your bladder through the urethra. This drains urine during the surgery and for a time afterward.

8. The surgeon will make several tiny cuts (incisions) in your belly.

9. The surgeon will insert several precision-guided robotic arms into these incisions. These arms hold and manipulate tiny tools to do the required tasks. A tiny video camera will also be inserted. It gives a magnified, 3-D image of the operating site.

10. The surgeon will sit at a nearby computer console. On the screen, they will see continuous, highly magnified images of the surgical area. Using the computer, the surgeon will control the robotic tools in real time.

11. The surgeon will find and examine the obstructed area. If part of the ureter is damaged, that part is removed. The lower cut end of the ureter will then be joined to the renal pelvis using stitches. In some cases the ureter and kidney are both cut. Part of the kidney is then used to widen the ureter.

12. If a blood vessel is pressing on the ureter, it will be moved away.

13. If you have kidney stones due to the UPJ blockage, these will be removed.

14. A long, thin, plastic tube (called a ureteral stent) will be put inside the ureter. This is to help hold the ureter open while it heals. It will stay in place for several weeks after surgery.

15. In some cases, a surgical drain may be put into your belly. This collects and drains excess fluid.

16. When the repair is done, the robotic tools and camera will be removed.

17. The small incisions on your belly will be closed. Bandages will be applied.

What happens after a robotic pyeloplasty?

In the hospital

 

• After surgery, you will be taken to the recovery room to be watched. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.

• You may get pain medicine, as needed, by a nurse. Or you may give it yourself through a device connected to your IV line.

• You will be encouraged to get up and walk soon after the surgery. Walking can help reduce any constipation you may have after surgery.

• You will be given liquids at first. But you can slowly add solid foods as you are able to handle them.

• A catheter or surgical drain may be removed the next day. If not, they will be removed at a follow-up appointment.

• You will have a follow-up appointment with your provider about 1 month after surgery. The ureteral stent will be removed then.

• Your healthcare provider will talk to you about any other follow-up care that is needed. This may include:

  • A CT scan and diuretic kidney scan about 6 to 12 weeks after the stent is removed

  • Continued follow-up for about 1 year. This is to assess if symptoms have improved and how well the kidneys are working.

   

 

Your provider may give you other instructions after the procedure, depending on your situation.

At home

 

• Follow all instructions from your healthcare provider.

• Keep all follow-up appointments.

• You may have some pain and discomfort. You will be given a prescription for pain medicine if needed.

• You will be told how to care for a catheter or surgical drain if you have them.

• Drink lots of water. Eat a healthy diet with lots of fruits and vegetables.

• Walking is good for you. But don’t do any heavy lifting or strenuous activity for 6 weeks after your surgery.

• It’s common to have some constipation after surgery. Walking can help to reduce that.

• Ask your provider when it’s OK to drive again.

• Ask your healthcare provider when it’s OK to have sex again.

 

Your provider will tell you when you can go back to work and resume normal activities.

Call your healthcare provider if you have any of these after surgery:

• Fever or chills

• Redness, swelling, bleeding, or fluid leaking from the incision site

• Leg pain or swelling

• Chest pain

• Upset stomach (nausea), vomiting, or belly cramps

• No bowel movement for 3 days

• Gas pain for 3 days

• Trouble peeing

• Blood in your urine

• Bad-smelling urine

Your healthcare provider may give you other instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure