Robotically assisted laparoscopic dismembered pyeloplasty: a chronic porcine study.

Objectives: To evaluate the feasibility and efficacy of robotically assisted laparoscopic dismembered pyeloplasty in an animal model. We also investigated whether the use of a device that lacks tactile feedback results in tissue damage and subsequent stenosis or leaking of the anastomosis.

Methods: Robotically assisted dismembered pyeloplasty was performed on 10 farm pigs. After 1 month, all pigs were anesthetized again for intravenous urography and to remove the kidney and ureter on the operated side. Histopathologic examination of all specimens was performed.

Results: All animals survived the initial procedure without complications. In the first five procedures, the time required for the performance of the anastomosis showed a decreasing trend. In the last five procedures, 30 to 40 minutes were required for the anastomosis. The results of urography showed mild hydronephrosis in 1 case (animal 7). The other animals showed no abnormalities. The histopathologic examination of the specimen showed a large foreign body granuloma in the ureteral wall of animal 7 that caused the before-mentioned obstruction. No significant abnormalities were seen in the other animals.

Conclusions: Robotically assisted laparoscopic dismembered pyeloplasty is a technically feasible procedure with an acceptable morbidity in an animal model. No significant histologic effects were seen of the possibly less-delicate tissue handling by the robotic device. The benefit of this technological progress has not yet been established. Therefore, the use of these techniques has to be thoroughly assessed before their clinical application.