Team of doctors led by veteran urologist Prof.Dr. Suresh Patankar and his robotic surgical team including senior urologist Dr.Gururaj Padasalagi,Dr.Sachin Bhujbal,Fellow Dr. Saurabh Uplenchwar, has 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 hospital with abdominal pain and was found to have the kidney located in the pelvis, instead of its normal natural 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 come linked with ureter obstruction and rarely with kidney stones. Treating such cases can be difficult due to the unusual position and structure of kidney ,short ureter, complex blood vessels and vicinity of intestines makes the procedure challenging during surgery. While laparoscopic surgery is safer and offer 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 of suturing for repair produces tearing of tissues making surgery even more difficult and increasing 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, less stressful for patients and surgeons.
Therefore, 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 straight forward because of the multiple stones, and there was a 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 operation table, we decided to remove the stone laparoscopically and endoscopically and simultaneously using a buccal mucosa, that is a skin inside the cheek, to repair the block.
This patient recovered smoothly and discharged on the 4 day after surgery. Follow-up showed 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 peer review of prestigious “Journal of Robotic Surgery” which stands amongst the top 25% of World databases.
Dr.Patankar further added that hospital have performed 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 3 D vision, improved ergonomics, and 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 Bhujbal, Fellow-Dr.Saurabh Uplenchwar, Anesthetist team Dr.Suchita Hardikar, Dr.Sonali Vaste Dr.Neha Banwat.