Robotic Pyeloplasty Corrects Common Kidney Malformation, Eliminating Need For Large, Scarring Incision
Dec 19, 2002
Physicians in the Departments of Urology and Pediatrics at NewYork-Presbyterian Hospital Weill Cornell Medical Center have become the first in New York City to perform robotic urologic surgery on a child. The procedure, robotic pediatric pyeloplasty, corrects a common congenital malformation that, if left untreated, will endanger kidney function. It is a less-invasive alternative to the traditional "open" method, which requires a large, scarring incision.
Dr. Dix Poppas, Chief of Pediatric Urology at NewYork-Presbyterian Weill Cornell and the Richard Rodgers Family Associate Professor in Pediatric Urology at Weill Cornell Medical College, performed the surgery on a seven-year-old boy from Wallington, NJ, correcting a uretero-pelvic junction obstruction (UPJ), a narrowing of the kidney where it connects to the ureter. As many as one in 200 children are born with a degree of hydronephrosis, a dilation of the inside of the kidney that results from obstructions to the flow of urine; a large majority of these cases are due to UPJ.
"Robotically-assisted pyeloplasty offers our young patients with UPJ several advantages," said Dr. Poppas. "Unlike the more common 'open' pyeloplasty, the robotic procedure will not leave a large, permanent, disfiguring scar, and unlike laparoscopic pyeloplasty, another surgical option, suturing of the ureter is easier, making the procedure safer." Other advantages of minimally invasive surgery include quicker recovery times, less pain, and shorter hospital stays.
The three-hour surgery was performed with the help of Intuitive Surgical's Da Vinci™ Surgical System, which has been approved by the Food and Drug Administration for a number of clinical procedures at NewYork-Presbyterian Hospital. The patient returned home after a three-day hospital stay and, according to Dr. Poppas, he is experiencing an uncomplicated recovery.
Dr. Poppas said, "Our patient was originally presented to his local physician complaining of left back and flank pain. He was subsequently diagnosed with severe UPJ and referred to Weill Cornell for treatment." Diagnosis of UPJ is confirmed by abdominal ultrasound, and although the condition is commonly detected in utero, it may only become acute years later.
Robotic pyeloplasties have been performed on adults since 2001, with a success rate of 90 to 95 percent. The first robotic pediatric pyeloplasty was performed earlier this year at Children's Hospital in Boston; however, less than ten have been performed in the U.S. to date.
Pediatric urologists at Weill Cornell have also performed among the first minimally invasive kidney removals in children and infants in the metropolitan area. Such laparoscopic nephrectomies, as they are known, result in shorter hospital stays, less post-operative pain, and less scarring.
Dr. Dix Poppas is also an Associate Professor of Urology in Pediatrics and Associate Attending Pediatrician at NewYork Weill Cornell Children's Hospital of NewYork-Presbyterian Hospital.