Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5802-5808
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5802
Robot-assisted laparoscopic pyeloureterostomy for ureteropelvic junction rupture sustained in a traffic accident: A case report
Si Hyun Kim, Woong Bin Kim, Jae Heon Kim, Sang Wook Lee
Si Hyun Kim, Department of Urology, Soonchunhyang University Cheonan Hospital, Cheonan 31151, South Korea
Woong Bin Kim, Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
Jae Heon Kim, Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul 04401, South Korea
Sang Wook Lee, Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
Author contributions: Kim SH and Lee SW provided the conceptualization and methodology, wrote original draft and completed review and editing; Kim SH, Kim WB, Kim JH and Lee SW completed data curation, validation and investigation.
Supported by Soonchunhyang University Research Fund, No. 20200024.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sang Wook Lee, MD, Associate Professor, Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, 170 Jomaru-ro, Bucheon 14584, South Korea. bartol@schmc.ac.kr
Received: August 22, 2020
Peer-review started: August 22, 2020
First decision: September 24, 2020
Revised: September 26, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 26, 2020
Processing time: 95 Days and 5.9 Hours
Abstract
BACKGROUND

Ureteral reconstruction is a highly technical type of laparoscopic or open surgery. The incidence of ureteral injury is low; however, ureteral injuries tend to be overtreated. Robotic surgery for urinary reconstructive surgery is growing in popularity, which has made procedures such as pyeloplasty, ureteroureterostomy, and ureteroneocystostomy possible, with minimal damage to the patient. To the best of our knowledge, this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea, in a 17-year-old female patient with a ureteral injury.

CASE SUMMARY

The patient, a 17-year-old girl without previous medical history, was presented at the emergency room and complained of abdominal and back pain. Tenderness in the right upper quadrant was observed on physical examination. Hemorrhage in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography (CT) scan. Ureteral injury was not suspected at this time. The patient was stabilized via conservative treatment, but complained of right flank pain 3 wk later and revisited the emergency room. An enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right kidney. Retrograde and antegrade pyelography were performed. Extravasation and discontinuity of the ureter were found. A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was performed. After 3 mo, the patient did not complain of any symptoms without any abnormal radiologic findings.

CONCLUSION

This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.

Keywords: Robot surgical procedure; Ureteral injuries; Minimal invasive surgical procedures; Reconstructive surgical procedures; Urology; Case report

Core Tip: The incidence of ureteral injuries is lower than other urinary tract injuries due to their anatomical features, located deep and surrounded by muscles or other organs. However, the small size, mobility, and location of the ureter made the operation difficult, and laparoscopic surgery was difficult to overcome the learning curve. Robotic surgery is a tool that can compensate for these shortcomings and treat patients less-invasively. This report might introduce the surgical methods and benefits of robot-assisted laparoscopic pyeloureterostomy, the first reported in Korea, and suggest that these methods can be used more widely.