Pyeloplasty for Children
Pyeloplasty is a surgical procedure to remove a blockage in the ureter, where it meets the kidney. When urine builds up in the kidneys and cannot properly drain out to the bladder, it's called hydronephrosis.
Hydronephrosis in children typically has to do with the formation of the ureter or location of certain blood vessels near the kidney before birth. It often resolves itself in a child's first two years, but can also worsen over time.
Pyeloplasty involves rearranging the "plumbing" near the kidney. Depending on the circumstance, this may involve:
- Taking out a segment of the ureter that is too narrow, or kinked
- Repositioning the ureter to make it drain more effectively
At Swedish, open pyeloplasty is typically done on infants. This open incision is very small, and babies recover quickly.
For children and adolescents, however, surgeons can use laparoscopy or the daVinci Robotic System to operate through very small incisions.
Robotic Pyeloplasty is done in an operating room, with a specially trained surgical staff. Patients are under general anesthesia, and constantly monitored by an anesthesiologist.
During this procedure:
- The surgeon makes three or four small incisions in the abdomen
- The abdomen is inflated with carbon dioxide to give the surgeon room to work
- Specially designed surgical instruments and a tiny camera are attached to robotic arms and precisely inserted through the incision
- Once the instruments are safely in place, the surgeon sits at a nearby console and controls every movement of the robotic instruments
- If a narrow segment of the ureter needs to be removed, it is cut out and the ureter reconnected
- The instruments then are removed and the incisions closed
With the enhanced optics of robotic surgery, the surgeon is able to see everything magnified and in 3-D through the viewfinder on the console. The precision instruments allow for the dexterity and control that a surgeon would have in an open procedure.
Kidneys are located deep inside the abdomen, underneath the rib cage. In adolescents and adults, an open pyeloplasty requires a long incision through muscles and tissue.
Open pyeloplasties typically result in a five- to seven-day hospital stay, and several weeks of recovery.
In comparison, children and adolescents who have a robotic pyeloplasty:
- Stay in the hospital one to two days
- Are back to school the next week
- Experience much less pain after surgery
Before robotic systems were available, this procedure was sometimes done with standard laparoscopy. But pyeloplasty is more technically demanding, with less precise instrumentation.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
Complications associated with robotic pyeloplasty are about the same as for open surgery: there can be a leak where the ureter is reconnected. Complications from robotic pyeloplasty are very uncommon.
Robotic surgical systems are now widely available, but that does not mean every surgeon has the experience needed for positive outcomes.
In talking with potential surgeons for your procedure, be sure to ask:
- How much robotic surgery experience they have
- How long robotic surgery has been available at their hospital
Swedish is a regional center for performing – and teaching – robotic surgery. More than 4,000 robotic procedures have been performed here.
Many of our surgeons are among the most experienced in the country. They have published the results of their comparative research, and teach robotic methods to surgeons from other medical centers.