The Role of Robotic Surgery For Managing Complex Upper Urinary Tract Stone Disease: A Single Center Experience

Year 2023, , 146 - 154, 30.09.2023

Murat Can Kiremit , Yakup Kordan

https://doi.org/10.54233/endouroloji.20231503-1350321

Abstract

Objective: The aim of this study is to present the outcomes of robotic surgery using a da Vinci robotic system (Intuitive
Surgical Incorporation, Sunnyvale, CA) in different clinical indications in patients with upper urinary tract stone disease.
Material And Methods: The data of 12 patients who underwent robotic stone surgery at our academic center
between July 2016 and July 2023 were retrospectively evaluated. The reason to perform robotic stone surgery was
large and/or impacted upper tract stone disease after a previous unsuccessful stone surgery (n=7), the need for a
partial nephrectomy due to simultaneously detected renal solid lesion (n=4), and the need for pyeloplasty resulting
from ureteropelvic junction obstruction (n=1).
Results: Out of 12 patients included in the study, 7 patients (58%) were male, and 5 patients (42%) were female with a
median age of 58 (IQR: 44 – 68) years. The median stone size was 38 mm (IQR: 16 – 53) as measured at a preoperative
computerized tomography (CT) scan. 7 out of 12 patients (58%) had multiple urinary stones while 5 patients (42%) had a
solitary stone. Assistance with flexible ureterorenoscopy was required in 7 out of 12 cases (58%). The median operation
time and estimated blood loss were 190 minutes (IQR: 126 – 148) and 50 ml (min:0, max: 300), respectively. In a case
who underwent concurrent partial nephrectomy, angioembolization was required due to postoperative bleeding. In
another case, prolonged drain activity (6 days) was observed which resolved spontaneously during follow-up. Stonefree
status was achieved in 11 out of 12 cases (92%). In the only case without stone-free status, the residual stone
was fragmented during JJ stent removal by the technique of retrograde intrarenal surgery (RIRS). After this additional
operation, stone-free status was achieved in all cases.
Conclusion: Robotic stone surgery with its high stone-free rate and low complication rate represents an alternative
approach in complex clinical scenarios considering the increasing experience of surgeons in robotic surgery.

Keywords

robotic surgery, flexible ureterorenoscopy, urolithiasis, complication

Project Number

Yok

Kompleks Üst Üriner Sistem Taş Tedavisinde Robotik Cerrahinin Rolü: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmanın amacı, farklı endikasyonlar ile da Vinci robotik sistem (Intuitive Surgical Incorporation, Sunnyvale,
CA) kullanılarak yapılan üst üriner sistem taş hastalığı tedavilerinin klinik sonuçlarını paylaşmaktır.
Gereç ve Yöntemler: Temmuz 2016 ve Temmuz 2023 tarihleri arasında merkezimizde robotik taş cerrahisi yapılan 12
hastanın verisi retrospektif olarak incelenmiştir. Daha önce geçirilmiş başarısız taş cerrahisi olan hastalarda büyük ve/
veya impakte üst üriner sistem taşı olması (n=7), eş zamanlı saptanan renal kitle için parsiyel nefrektomi gerekliliği (n=4)
ve üreteropelvik bileşke (UPB) darlığına bağlı eş zamanlı pyeloplasti gerekliliği (n=1) sebebi ile robotik taş cerrahisi
planlanmıştır.
Bulgular: Çalışmaya dahil edilen 12 hastanın 7’si (%58) erkek, 5’i kadındı (%42) ve ortanca yaş 58 (IQR: 44–68) yıldı.
Preoperatif BT değerlendirmesinde taşların ortanca boyutu 38 mm (IQR: 16–53) olarak bulundu. Hastaların 7’sinde
(%58) çoklu taşlar var iken 5’inde (%42) soliter taş saptanmıştı. Hastaların 8’inde (%66,7) robotik pyelolitotomi ve/veya
nefrolitotomi uygulanırken dört hastada ise robotik üreterolitotomi uygulandı. Cerrahi esnasında hastaların 7’sinde
(%58) eş zamanlı fleksibl üreterorenoskopi ile endoskopik asistans gerekti. Ortanca ameliyat süresi ve tahmini kan kaybı
sırası ile 190 dk (IQR: 126–148) ve 50 ml (min:0, maks: 300) olarak saptandı. Eş zamanlı parsiyel nefrektomi yapılan
bir hastada hemoraji görülmesi üzerine transfüzyon ve ardından endoskopik psödoanevrizma embolizasyonu ihtiyacı
oldu. Robotik pyelolitotomi yapılan bir hastada ise kendiliğinden azalan uzamış dren aktivitesi (6 gün) görüldü. Ameliyat
sonrası yapılan tetkiklerde hastaların 11’inde (%92) tam taşsızlık sağlandığı görüldü. Rezidü taş görülen hastada ise
JJ stent çekilmesi esnasında retrograd intrarenal cerrahi (RIRC) yapılarak 8 mm boyutundaki rezidü kalkül fragmante
edilerek mutlak taşsızlık sağlandı. İlave girişim sonrası hastaların tamamında mutlak taşsızlık görüldü.
Sonuçlar: Kompleks klinik senaryolarda robotik cerrahi, tek seansta yüksek mutlak taşsızlık ve düşük komplikasyon
oranları yanında cerrahların artan robotik böbrek cerrahisi deneyimi de düşünüldüğünde büyük böbrek taşlarının
tedavisinde de alternatif olarak hastalara sunulabilir.

Keywords

robotik cerrahi, flexible üreterorenoskopi, ürolitiyazis, komplikasyon

Ethical Statement

Koç Üniversitesi Etik Kurulu, onay numarası: 2023/307.IRB1.103.

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

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