Robot-assisted pedicled colonic flap pyeloplasty for the treatment of complicated ureteropelvic junction obstruction: technique and outcomes from a single center.

backgroundThe treatment of complicated ureteropelvic junction obstruction (UPJO) is challenging. We introduce robot-assisted pedicled colonic flap pyeloplasty (RA-PCFP) for the treatment of complicated UPJO.

methodsFourteen patients (eleven females, three males) who underwent RA-PCFP between December 2020 and November 2023 at our center were included. Data were retrospectively collected, and outcomes were assessed. RA-PCFP was performed via two techniques. The first was the onlay pyeloplasty, in which the inferior renal pelvic flap and ureter were directly anastomosed without tension, and a pedicled colonic flap (PCF) was placed into the ventral defect. The second technique was the modified Yang-Monti colon pyeloplasty: when tension-free anastomosis was not feasible, one colonic flap was used to reconstruct the dorsal ureter, followed by one or two additional colonic flaps placed on the ventral side to cover the defect. Perioperative parameters and follow-up details were evaluated.

resultsEight patients (57.1%) underwent onlay pyeloplasty with augmented anastomosis, whereas six (42.9%) underwent the modified Yang-Monti technique. The median (interquartile range, IQR) operative time was 298 (IQR: 245-367) min, the length of the colon segment was 2.5 (2.0-5.5) cm, and the estimated blood loss was 100 (50-150) mL. No conversions to open surgery were required and no intraoperative complications were observed. At a median follow-up of 30 (12-36) months, the overall success rate was 92.9% (13/14).

conclusionRA-PCFP is a safe and feasible surgical approach for managing complex UPJO, particularly in patients with a constricted renal pelvis following failed pyeloplasty.