The robot assisted pyleoplasty

Akkoeze M., Kusche D.

Prosper Hospital, Dept. of Urology, Recklinghausen, Germany

INTRODUCTION & OBJECTIVES: Minimal invasive surgery has gained widely acceptance in all operative disciplines. This generaltendency is nowadays due to the Da Vinci technology even moreincreasing. Rising again the question for robotic adjusted operationtechniques to perform the desired procedure. We would like todemonstrate with this “step by step” teaching video our technique to perform a robotic dismembered pyeloplasty. This video was designedas part of an entire teaching concept to support urologist who want toincorporate robotic technology into their armamentarium.

MATERIAL & METHODS: After the demonstration of the bedding ofthe patient and the portplacement we are showing a fully standardizedprocedure, which is divided in 10 chapters. Our presented technicalmodifications for the resection of the renal pelvis, the ureter spatulationand the anastomosis made this procedure much easier and more timeeffective with good results. They will be shown with graphics inparticular to support a better spatial imagination. To ensure acontinuously orientation during the operation we have colored andnamed the crucial anatomical landmarks in this video. The chaptersare: 1. Positioning of the patient 2. Positioning of the ports 3.Mobilisation of the descending colon 4. Identification of the ureter 5.Mobilisation of the renal pelvis 6. Resection of the pyelouretericjunction 7. Anastomosis of the renal pelvis and the posterior uretericwall 8. Antegrade ureteral catheter insertion 9. Anastomosis of therenal pelvis and the anterior ureteric wall 10. Completed anastomosisand postoperative result

CONCLUSIONS: We think due to the clear structure, the anatomical overview highlighted by colored anatomical landmarks, graphics andthe given standardized operation technique this video is a suitabletraining tool for urologist who want to start in robotic surgery.

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