Robotic Pyeloplasty - Robotic Surgery

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Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

A pyeloplasty is used for PUJ obstruction. 

So what that is is patients have a renal pelvis so the kidney drains urine into something called the renal pelvis and then there’s a thin tube called the urina that takes that down to the bladder. 

When you have a narrowing at the renal pelvis that obstructs the kidney and that’s called PUJ obstruction. 

Patients usually present with symptoms such as, it’s very similar to kidney stones with severe pain. 
Sometimes it’s incidentally found. 

Traditionally this has been treated with a big open incision and it’s quite a large incision right along the, the loin area and it’s two to three month recovery, seven to 10 days in hospital. 

I have been performing PUJ treatments in a minimally invasive method, so I’ve presented this nationally and internationally. 

For some patients we do it endoscopically through the eye of the penis. 

We go up there with a little telescope, we use the holmium laser and incise the, the obstruction, put a balloon that stretches it up, puts, we put a stent in and leave that in for six weeks and then take the stent out. 

That’s called a laser endopylotamy. 

The risks of that are that you can get bleeding if there’s some adjacent vessels there. 

It’s not very good if the blockage is very large but it’s good for patients who have had failed treatment and patients that don’t want to have any form of either surgery. 

The success rates are slightly lower than with surgery, with open surgery, with a success rate of about 75% or so. 

But I presented this data internationally and we’ve been very happy with those outcomes. 

The other way of treating this is either via laparascopic or robot assisted method and I’ve been very fortunate to have our robot donated to our hospital. 

I’ve presented the robotic pyleoplasty data and really I think it’s transformed this condition. 

Basically patients used to have small incisions made. 

We have the robotic device that comes in and attaches, I unscrub, I sit at a console, I move my hand controls, as I move my hand controls the instrument inside the abdomen and replicate my hand movements. 

We have gas pressure in the abdomen which creates space. 

We actually have a third arm, a spare arm that I press the pedal on and it activates to retract the bowel. 

So the narrow segment gets excised, the robotic arms have more degrees of movement than your wrist so we can move the instruments around. 

We cut the narrow segment and then we can stitch it up.  So we, we, the robot allows 10 times magnification. 

It’s a three dimensional view, it’s like doing the operation with an operating microscope and we do a very, very accurate join. 

So patients are usually out of hospital in about two days with this method but most importantly it’s their recovery, they’re back up and about in about a week or so as opposed to two to three months.

I also did this laparascopically but the instruments when you do it laparascopically and just open and close they don’t rotate around and it’s much harder to do a very accurate join. 

So I believe that really robot assisted pyleoplasty should be the gold standard in patients with PUJ obstruction and certainly patients who have PUJ obstruction should at least be informed about this treatment option and consider this option. 

I think if patients really knew about it the majority of patients would elect to have this done. 

So far we’ve had an excellent success rate with all our patients having complete relief of obstruction and really the literature shows the success rate is 95% plus. 

So previously I used to do a lot of endopylotamies rather than the open incision but now patients tend to go for a robot assisted pyleoplasty with a higher success rate than endopylotamy and they have the advantage of minimally invasive surgery.