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Laparoscopic robotic pyeloplasty using the Zeus Telesurgical System

Patrick P.W. Luke, Andrew R. Girvan, Mohammed Al Omar, Kenneth A. Beasley, Michael Carson

Division of Urology, London Health Sciences Centre, Canadian Surgical Technologies and Advanced Robotics, The University of Western Ontario, London, Ontario, Canada
Address correspondence to Dr. Patrick Luke, London Health Sciences Centre - University Campus , 339 Windermere Road, London, Ontario, N6A 5A5 Canada

Canadian Journal of Urology 2004, 11(5), 2396-2400.

Abstract

We present the initial clinical experience using a robot to perform a laparoscopic dismembered pyeloplasty at a Canadian centre. Five patients were confirmed to have ureteropelvic junction obstructions through nuclear renography, cross sectional imaging and intravenous pyelography. After performing a retrograde ureteropyelography and double J stent placement, laparoscopic dismembered pyeloplasty was performed by a single surgeon at a remote workstation using the ZeusTM Telepresence Surgery System (Intuitive Surgical‚). The mean total operative time was 225±48 minutes, anastomotic time was 71±16 minutes, and the mean time required to set-up the robot was 30±17 minutes. The estimated blood loss was less than 100 ml in each case. A mean total of 22±10 mg of morphine sulfate equivalents were used for analgesia, and the patients were discharged home after a mean of 58±10 hrs. There were no robotic failures, and all evaluable patients are free of pain and demonstrable obstruction. One patient developed a delayed urine leak, which resolved with percutaneous drainage. The robot provides the ability to perform complicated operations with precision through elimination of tremor, scaling of motion, and through the use of ‘wristed’ instruments that enhance the freedom of movement normally limited by straight-shafted laparoscopic needle drivers. The development of robotic telesurgery is still in its infancy, and the significance of its role in urologic surgery continues to be evaluated.

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