Robot-assisted laparoscopic pyeloplasty for the management of pelvi–ureteric junction obstruction in horseshoe kidneys: initial experience

Minimally invasive dismembered pyeloplasty has become the gold-standard treatment for symptomatic pelvi–ureteric junction obstruction (PUJO) in recent years. A small proportion of patients with PUJO have horseshoe kidneys. We present two cases of robot-assisted pyeloplasty in horseshoe kidneys and describe the technical modifications for success in these cases. Two patients, aged 28 and 35 years, were diagnosed with symptomatic PUJO in horseshoe kidneys. Both had a robotic-assisted laparoscopic dismembered pyeloplasty using the da Vinci^® surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Three-dimensional computed tomography (CT) reconstructions were performed pre-operatively to plan surgery. The transperitoneal ports were placed more caudally than usual for improved access to the PUJ. The isthmus was not divided in either case. The procedures took 190 and 90 min, respectively, with minimal blood loss and no post-operative complications. Patients were discharged on post-operative day 2 following catheter and drain removal. Follow-up diuretic renograms showed no residual obstruction and patients were symptomatically better. Our initial experience suggests that RALP is a safe and feasible option for the treatment of PUJO in horseshoe kidneys with good short-term outcomes. These are challenging cases and robust pre-operative planning combined with technical modifications has been beneficial to our success. The enhanced suturing possible with the da Vinci^® surgical system facilitates these procedures.