PUNE: A Team of doctors led by veteran urologist Prof.Dr. Suresh Patankar and his robotic surgical team, including senior urologist Dr.Gururaj Padasalagi, Dr. Sachin Bhuiyan, Fellow Dr. Saurabh Uplenchwar, have successfully performed a complex surgery of robot-assisted laparoscopic Pyelolithotomy with concomitant buccal mucosal graft ( BMG) Pyeloplasty in a patient with ectopic pelvic kidney. This new technique in surgery marks a major step in the use of robotic technology in complicated kidney conditions. It is believed to be the first such documented procedure in the world of robotic surgery. This has been confirmed by the prestigious Journal of Robotic Surgery, Germany.
Giving details about the case, Prof.Suresh Patankar, chairman of Ace hospital, Erandwane, Pune, said that a 41-year-old man came to the hospital with abdominal pain and was found to have a kidney located in the pelvis, instead of its normal position. Along with multiple kidney stones, there was a blockage at the Junction, between the kidney and the joining ureter. Traditionally, such cases are extremely difficult to treat due to abnormal anatomy and the higher risk of complications.
An ectopic kidney is a very rare birth condition that is often linked with ureter obstruction and rarely with kidney stones. Treating such cases can be difficult due to the unusual position and structure of the kidney, short ureter, complex blood vessels, and the vicinity of intestines makes the procedure challenging during surgery. While laparoscopic surgery is safer and offers faster recovery compared to open surgery, it can be technically demanding and time-consuming for surgeons. Patients with long-standing kidney stones can cause inflammation, scarring, and make tissues friable; hence, any attempt at suturing for repair produces tearing of tissues, making surgery even more difficult and increasing the risk of bleeding, infection, and other complications. Earlier, medical guidelines recommended performing such operations in 2 stages. However, with robotic technology, complex surgeries have become safe, more efficient, and less stressful for patients and surgeons.
Therefore, the Ace robotic team decided to go with a robotic surgery, added Prof. Patankar. Using a robotic surgical system, we were able to precisely remove the stones and repair the kidney in the same procedure. But this procedure was not simple and straightforward because of the multiple stones, and there was significant damage to the ureter. Hence, the challenge was how to overcome this problem, and there are no guidelines as such to repair this problem. So on the operating table, we decided to remove the stone laparoscopically and endoscopically, and simultaneously, using a buccal mucosa, that is, the skin inside the cheek, to repair the block.
This patient recovered smoothly and was discharged on the 4 day after surgery. Follow-up showed a good result and no further blockage. A detailed review of existing medical literature confirmed that this is the first reported case where both procedures, stone removal and a graft repair, were done simultaneously on an ectopic pelvic kidney with robotic assistance. Our claim has been confirmed by a peer review of the prestigious “Journal of Robotic Surgery,” which stands amongst the top 25% of World databases.
Dr.Patankar further added that hospitals have performed a large number of robotic procedures mostly for the kidney, prostate, including cancers, and reconstructions. But this procedure was a milestone and highlights how robotic surgery is revolutionizing urology, making even the most challenging procedures safer, precise, and more comfortable for both surgeons and patients. With greater flexibility of movement, enhanced 3D vision, improved ergonomics, and the wise thinking of the surgeons, it allows surgeons to perform complex operations with more precision and comfort. This gives a safe and better outcome for the patients.
The team of doctors included, along with Prof. Dr.Suresh Patankar, senior urologist Dr.Gururaj Padalsalagi, Dr.Sachin Bhuiyal, Fellow-Dr. Saurabh Uplenchwar, Anesthetist team, Dr.Suchita Hardikar, Dr.Sonali Vaste, Dr.Neha Banwat.