Intraoperative Evaluation on the Utility of the Vascular Hitch Technique During Robotic Pyeloplasty
Michael S. Tonzi, MD1, Nicholas Cost, MD2, Jonathan Walker, MD1.
1UTC Chattanooga, CHATTANOOGA, TN, USA, 2Children's Hospital Colorado, Denver, CO, USA.
When clinically indicated, symptomatic UPJ obstruction is often surgically managed by dismembered pyeloplasty. This is done in a robotic or open fashion, depending on patient age and surgeon preference. While classically associated with a high success rate, this technique requires a ureteral-pelvic anastomosis which has an associated risk of urine leak and potential recurrence. Additionally, many surgeons leave postoperative stents following repair, which can cause patient discomfort and require additional anesthetic to remove. In the setting of a crossing vessel, the transposition technique, otherwise known as the vascular hitch, has been demonstrated to resolve select cases of UPJ obstruction secondary to extrinsic compression without the need to perform a dismembered pyeloplasty. The appropriateness of this technique requires careful intraoperative assessment.
In this video, we compare two cases of UPJ obstruction in patients with crossing lower pole vessels and contrast the appropriateness of the vascular hitch technique. We identify key factors in defining the utility of this technique on a case-to-case basis.
Following surgical repair, both patients experienced symptomatic resolution at their 3 month follow up. Resolution of their hydronephrosis was confirmed by post-operative renal ultrasound which demonstrated complete resolution in patient A (repaired by vascular hitch), and significant downgrading in patient B (repaired by dismembered pyeloplasty).
In appropriate patients, the vascular hitch technique is an effective tool in resolving symptomatic UPJ obstruction. However, careful intraoperative evaluation must be performed on a case-to-case basis to determine the appropriateness of this technique.
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