Laurence S. Baskin, MD, UCSF’s chief of pediatric urology, offers an exciting look at how specialists are using the da Vinci robot to enhance the precision of pediatric pyeloplasty. Illustrating treatments for three common causes of blocked kidneys, this video update includes high-resolution resection and suturing visuals, and illuminates how a robotic method can minimize pain and recovery time.
mm mm mm. Hi, I'm Lawrence Baskin, chief of pediatric Urology at UCSF Benioff Children's Hospitals. Today, I'd like to talk about our experience with robotic surgery for blocked kidneys. Block kidneys come in many varieties, most commonly prenatal diagnosis and secondarily, Our young patients who come in with severe abdominal pain lasting anywhere from 4 to 12 hours, often associated nausea and the pain is severe enough to bring them in to the emergency room, diagnosis can be made with cT scan, ultrasound or MRI Here's an example of a CT scan and you can see the left kidney. There's lots of fluid or a very hydro defrauded kidney causing the severe pain comparing this to the normal kidney. On the right patients with prenatal diagnosis are typically diagnosed with ultrasound. On the left. You can see two hydro defrauded kidneys. The black area represents the urine stuck up in the kidney, comparing that to the normal kidneys on the right where you don't see any hydro necrosis. This is a schematic of irritable pelvic junction obstruction and you can see with the blue arrow there's a kink and the urine is not allowed to drain, causing the severe pain and blockage of the kidney. There's three main ideologies that cause this. The first is an intrinsic obstruction kind of kicking of the ureter. The second is an extra blood vessel and the third quite rare is a urethral polyp. We'll show you all these with our robotic technique to fix it. This is a da Vinci robot on the right. You can see my partner Hillary cop, both of us doing robotic surgery and on the left you can see the robot with our patient docked and our nursing team. The robot doesn't do the surgery by itself, which would be nice. We could simply then just get a cup of coffee and have them fix the blockage. But what we have to do is guide the robot and use all of its sophistication for high magnification and the ability to, so with a precision fashion, robotic surgery is done with tiny ports in the case of Children and with the newer X. I. Robot. The ports are placed in the belly button, one below the bikini line, and one dis underneath the rib cage in what I call a power I formation. In the bottom picture, you can see the port site looking into the abdomen. Our goal is to find the obstruction cut out the bad area and sew it back together. Here's an example of a patient who has an intrinsic obstruction. You can see the ureter to the right and you can see the dilated renal pelvis where the water or urine is stuck up in the kidney. Here's an example of a patient who has an extra blood vessel or a crossing vessel. This blood vessel, which goes to the lower part of the kidney intermittently causes the renal pelvis to kink over the blood vessel, causing extreme pain. You can see the robotic arms picking up the ureter, and we can see with the laser pointer, the blood vessel that's underneath the goal here is to allow the blood vessel to drop below the ureter by opening up the blocked area here and allowing the ureter then to be reinvested, most or sewn over the crossing vessel. This is the third and most rare case in this patient, he actually had urethral polyps that caused the blockage within the ureter here, we simply excise the polyps and use the robot to so things back together. Well, how do we do the operation? We define where the abnormality is. In other words, the kink or the original pelvic junction, where the blockage or the extra blood vessel is we dissected out. And then we open up the renal pelvis and you'll see a gush of urine from the bloc kidney. We then cut out the renal pelvis, we spatula at the ureter and we sew it back together. Here's an example of sewing with the robot, which allows us to be quite exact and with excellent precision, with super high magnification, you can see this image the little white plastic stent in robotic surgery, we insert a little stent which stays temporarily, which allows our anastomosis or our repair to heal perfectly for excellent long term success robotic pilo plasticky has been a great boom for us. It allows very small scars, but more importantly, it allows our patients who are older to get back to school, to get back to their soccer team and allows our younger patients to heal quite quickly and their families to get back to work with, really a minimally invasive approach one night in the hospital, an excellent long term success for the health of the kidney. Thanks for your attention. If you need help with your patients do not hesitate to reach out. We see patients both at Mission Bay and at Oakland Children's as well as our outreach clinics. We can be reached at (415) 353 2200. Yeah, yeah.
