598
240193226014562118181
Ces8507936014570127174
Urol10497936014578115180208
2018;12827936014562121176230253
22(4):15617936014561121152208239261
238–24118477936014562122182244299355408
VIDEO852207016978121223301405
Závěr:1000893013563121175231271298
Roboticky1323898013165124185246279301350397449
asistovaná179789801315999121161196253302353412461
pyeloplastika2283898013170118170194253314338387428463486532583
je289189801313286
efektivní850104801315381134179216238287346368
minimálně12441048013190112169191280329351408461
invazivní1729104801312583130180224247296355377
metoda21321048013190143176232292341
pro2499104801316193149
korekci26721048013149106138189235282304
obstrukce8501198013159120161196228287333381433
pelvi‑ureterálního13071198013170124147197221254314346398432483515566589647669730789
přechodu.21201198013170102154204263322383441460
Obvykle26131198013174136185238285310363
je850134801312476
spojena9501348013149109168191243301350
s13241348013149
dlouhodobým1397134801316890149207265323383441502549640
vyřešením20611348013157110142193234287345366455
obstrukce25401348013167127167202234292338385436
u8501498013158
většiny9321498013150102135176198255301
operovaných12571498013159119173204261309359417463510568
pacientů.18491498013161111159181234292323381398
KLÍČOVÁ8521784014770132164236320392464
SLOVA13431784014762123207279351
Roboticky‑asistovaná,8501948013157118181243277301352399453488539581604645681740791843903954974
pyeloplastika,18501948013174123178202263326350401443480503551604624
obstrukce,25001948013171134176213246307355404458476
pelvi‑uretrální8502098013161115137186209242301333384417449499521579600
přechod,1474209801316193144194251310370388
hydronefróza.18862098013159105163195251310363391424480523573592
SUMMARY8522384014762143243345423493561
Študent1000254801315181139198251308340
V13602548013156
ml.,14362548013190112130148
Hartmann16042548013169118149186275323381438
I,2066254801311937
Šarapatka21232548013151101132182241291322368418
J,2565254801313451
Študent2636254801315182139198251308340
V.850269801315770
Robot-assisted9462698013165126188249283313364405446469509545598661
dismembered1632269801317093133225280371433489522575638
pyeloplasty22952698013171120174197257320344394436472525
for2845269801313897131
ureteropelvic850284801315890141174225257313373427450499522570
junction1444284801312481139187223245303362
obstruction.18302848013158119159193225283332368390448506525
Introduction:1000299301352994134175239305370421464493557622649
In1676299801313191
this17942998013142102126167
video1987299801315883144199261
we22822998013179134
present24422998013169103157199254314348
our28172998013166126160
experience8503148013152100161215247271324382431482
with13553148013178101136194
robot-assisted1574314801312986147206239269318358399421461496547608
pyeloplasty22053148013159107159183241301325375415450502
(RAP).2732314801312681147201228244
Our8503298013175137172
first1049329801314066101145183
experience12593298013165116180237272298354415468522
with18193298013181106143204
laparoscopic2051329801313486149203237298341393453517542594
pyelo‑26723298013173123179204266304
plasty850344801316288139182220274
dates11513448013171123158213256
back14343448013172125177226
to16863448013145105
2006.18183448013165119178235257
RAP21023448013167136194
brings23233448013172107132193256298
several26483448013152108160215250303328
subjective8503598013142102166192248302342367420476
advantages13533598013162126179233295330383447504548
such19283598013153113166228
as21833598013162105
3D23163598013165139
vision2482359801316288131155217279
and27893598013162124187
greater850374801316195149201236290324
dexterity12013748013171127178217272306331368422
of16503748013170101
laparoscopic1778374801313486148201236295338390449513538590
instruments,2395374801313394136174209270363419480515560581
which8503898013180142166217278
facilitates1155389801314093145169194218254307342396439
especially16213898013164107170227279304355380404455
the21033898013145106162
reconstruction2292389801314398150209271313350385446498537561622684
phase8504048013161122173214270
of1148404801315989
the1264404801313696151
surgery.14424048013143102135195250284338353
Material:10004193013593151190248289318375404430
Between14634198013157112147231285340400
March18974198013187138171219279
201422014198013164117167215
and24414198013160119181
August26474198013174133194253294330
2018,8504348013155107156204223
we11074348013180134
performed12664348013170125158191249282374429490
5017814348013163116
RAPs.19224348013165132188228248
The21954348013160122176
first239643480131366395137172
4725934348013163113
cases27304348013159110151205246
were8504498013179132163215
done10944498013160118176229
using13484498013163103124182241
2nd16134498013159167045040763470
generation17644498013165118176229261311343365423481
DaVinci®22754498013171119171195253301323365
S™26644498013157121
sys‑2809449801314796137167
tem.850464801313485175194
Now10774648013170129208
we13174648013180132
work14824648013179137169216
with17304648013180103136195
4th19494648013162201046540762055
generation20894648013168122180233265315348370428487
DaVinci®26084648013172121173197255304326368
Xi™850479801316183149
system.10244798013150100141176228319338
Using13954798013170109131189250
the16694798013143102156
transperitoneal1850479801314275126185225285340372395429486546600649671
approach25464798013159119181213271322371430
we8504948013179131
start1001494801314176125156193
with12144948013179102135193
open14274948013158118172230
access1677494801315098144195235274
for1975494801312582114
the2113494801313088141
30°22744948013154106139
laparoscope.2437494801311968127177208264304352408468522539
We8505098013190139
use1009509801315897149
four1182509801312581138169
8mm13715098013153142230
trocars1625509801313061117166215246286
for1935509801312481113
robotic2071509801312984144203235256304
arms2395509801314980169208
and26235098013150107165
one28085098013158116169
12mm850524801315398185273
trocar1147524801313062118167217248
for1418524801312582114
the1556524801313088141
assistant.1717524801314989128149188222272329361380
In2120524801312077
some2217524801314199188241
patients24785248013161111142164217274306347
we28455248013179131
use850539801315998152
transmesocolic1026539801314274124182222311364405463513569593614663
approach.17135398013158118179211268318367425444
The21815398013160120174
ureter2379539801316798150183234266
is2669539801313171
then27645398013142101154212
identified850554801312382135193225247273299352412
and12845548013150107167
traced1475554801313163113162212273
cranially1769554801314980130188210258280302350
towards2143554801313187166215247304344
the2511554801313189142
kidney.2675554801314670129187240288301
The8505698013152114169
renal1044569801314295155205229
pelvis12985698013171126150201225265
is1588569801313273
exposed16865698013163112175236277332394
to21055698013144102
enable22325698013163123173235259313
dismem‑2571569801316992133224279370405
bered8505848013161116147199260
pyeloplasty.11345848013170117170193251312335384424459511525
We16915848013191142
either1857584801316284117176230261
resect2143584801314092133186236273
the24405848013143101155
stenotic2619584801314984136194253286308357
part8505998013161111142179
of1054599801315987
the1165599801313593146
proximal1336599801316193149195218306355377
ureter1738599801315990142175226257
or2020599801315991
we21365998013179131
place2292599801316184133181232
the2548599801313593147
ureter2720599801315889141174225256
ventrally8506148013150101159190222272294315363
to1237614801313086
the1347614801313088141
crossing1508614801314980136176216237294353
vessels18826148013149101141181233256294
(if220061480131264775
present).2295614801316193144184237295326354369
In2688614801311977
case2785614801314999138191
of850629801316089
large964629801313282114173228
hydronephrosis12176298013168115175207265325380441501533591632654694
the19366298013143102157
renal2118629801314194153203226
pelvis23696298013171126149200223263
can26576298013159110169
be28516298013170125
resected.850644801313387129185236274327390410
Reconstruction12866448013166121173231292333369403464514552576636697
is2008644801313373
usually21076448013169110169220243266316
done24496448013170131192247
using27216448013169110133193255
6–08506598013154111168
Monocryl™10486598013185144202261310342393417481
suture.15536598013146103136194225277294
In1871659801312987
all198265980131557799
patients21116598013160110143165217275307349
we24896598013180132
use26456598013164103156
the2825659801314098151
DJ8506748013171104
stent,978674801313873124182213232
which12316748013180138160208266
is1521674801312059
kept1601674801314798158191
in1816674801312078
place1915674801316083132181232
for2171674801312583115
423076748013153
weeks.23826748013179131185231274294
We26976748013190140
do28586748013160118
not8506898013159117150
always1024689801315072150200246287
place1335689801316184133181232
a15916898013150
drain1665689801316091141163221
next19106898013159112160196
to2130689801313490
the2244689801313593146
kidney2414689801314670129187240288
(ERAS2726689801312979133198250
principle),850704801316193115173221243303326378404419
only12907048013158117139187
in1501704801311977
case1598704801314999139192
of1810704801315987
largely1921704801312068100158210233281
resected2226704801312980121174223259310370
pelvis26177048013161115137186209248
or2886704801315890
inflammatory850719801312380106132181269358407439494526578
changes14487198013149106155213272324365
of1833719801315886
surrounding1940719801314197128160216274332391413470529
tissues.249371980131305291131187240280299
The28127198013151111164
surgery850734801314197129187240271323
is1197734801312362
done12837348013160118176229
in1536734801312381
a16417348013150
standard1715734801314176125183243291323380
general21207348013159112170223255305327
anaesthesia24717348013150108156209250284342395435457505
with8507498013181104139198
commonly10747498013158115207298358418442491
used15907498013168108163225
postoperative18407498013170131172208265327383415467500523574627
analgesics.24927498013159119169192253307349371421464484
Ultrasound850764801316991124156206245304362419479
of1354764801315887
the1465764801313492145
kidneys1634764801314872131189242289330
(US)1988764801313097145173
in2185764801312481
222917648013154
and23697648013150108168
925617648013154
months26407648013190148207239297336
after320389801315078116167198
surgery,3425898013149106137195248280332345
diuretic379489801316889146178229262285333
scintigraphy415189801314998120177209231290322372431490536
one4711898013167126179
year4914898013156108156188
post5126898013169128168203
operatively32031048013158117170200249281302350401423470
and36921048013150106165
subsequent3876104801314096154193245304360412469500
US43951048013168115
every45291048013153101152182233
6–1247811048013153110155199
months49991048013189146204235292330
is3203119801312362
done32891198013160118176230
during35431198013159117148170228287
the3854119801313492146
follow4024119801312886109130188267
up.43151198013158118135
Presented3353134301356299155199255317353408471
case:38461343013555110154210234
A41081348013165
29-year-old41961348013160111145192243290319347406428486
female4705134801313586175222243295
patient50281348013162111141162213270301
was32031498013179127164
diagnosed3394149801316079125182238294332383441
with38611498013180100131187
a40701498013154
right4146149801313757114170199
hydronephrotic43721498013159102159188242298349407463492546577596642
kidney.5036149801315173130186236282293
The32031648013151109160
CT33911648013163115
showed35281648013147103159235285343
a38931648013156
primary3977164801316191111198245274324
hydronephrosis43291648013159103159188243299350408464494548586605642
with49991648013179100131187
no52141648013159115
stone3203179801314277133192245
and34721798013161119179
significant3674179801315273132190211237264313363421453
delay41501798013171124146195242
in4415179801313391
contrast45301798013160116175206238288328362
excretion49161798013164112159190242274296354413
during32031948013160116145166222280
the3505194801314097148
excretory36761948013159105151180230261316346396
phase,41001948013162119166204255270
the4392194801314197149
cortical45631948013155110140175195242290310
renal4896194801313888144192212
scan5130194801314795143199
showed3203209801314196152228278336
47%35592098013154100177
split3756209801314198119139170
renal3948209801313080135182202
function4172209801312783139185219239295351
of4543209801315985
the4650209801313288139
affected4809209801315076106156203237286344
kid‑5173209801314768125156
ney.32032248013159110155167
Pre-stenting3395224801315684133166204236285340370390445502
was39232248013180127165
done41132248013160116172223
for4358224801313388118
significant4498224801314463120176195219246292340395425
loin4945224801312783103158
pain.51292248013161108128183200
We32032398013190138
performed33572398013161112141171226256343394452
transmesocolic3825239801313464111167204290341379435482535556575621
RAP.44622398013156119171174
We46522398013190138
found4812239801312377133188246
acces‑5074239801315096140189226255
sory3203254801314198129179
crossing3404254801315685141179217237293351
vessels37772548013156107145183235256293
during40982548013161116146167223281
the4401254801314197149
surgery.45722548013148103132189240270320332
The49262548013158116168
renal5116254801313989145193213
pelvis32032698013162115136184205242
was34742698013181129168
not36702698013160117148
resected3841269801313989128180228263313372
and42362698013157113172
the4430269801314198150
anastomosis46022698013157114161200233288377434473493530
was51612698013181129168
done32032848013161117175226
mostly34582848013191148186219240287
using3773284801315997117173231
6–040262848013161117173
Monocryl™42272848013187144201258306336386408471
suture.47202848013148103135192221271287
The50292848013158117168
DJ52262848013172103
stent3203299801314071118172201
was34182998013178124160
placed3592299801316080125169216273
for3886299801312175103
4weeks.40042998013152144193243285325341
The43592998013150106155
console45292998013148100154190244264313
timewas4857299801313352136185277323359
935231299801315298
minutes32033148013190110165220251300338
and35583148013150106163
there3743314801312985136165214
were39743148013180130159208
no41993148013159115
intra-4336314801311873103133180212
and45653148013150105162
peri-operative47443148013161113142163193252310362391438468488535585
complications.32033298013149103190248268288334381411431487543580598
Results:33533443013562118164225253291336361
Twenty-five37333448013151122173231262313345372398447498
women42513448013179136225278335
and46063448013150107166
2547923448013153105
men49173448013190143200
with51373448013179101134192
mean32033598013191145194253
age34813598013159119173
5036793598013162115
(median38193598013137125179240263312371
31)42143598013163110131
were43783598013180133166218
included.4621359801313190139162220281334396415
Right-5061359801316487147206239268
sided3203374801314264124178240
pyeloplasty34683748013170118171195254315339389430465518
was40193748013181131172
done42163748013169128188243
in4483374801313291
58%45993748013163116198
of4821374801316897
patients.49433748013170121154177231290323366386
Pre-stenting3203389801315788142178219255308368401424484545
was37823898013181132174
done39813898013170130190245
in4251389801313292
38%43683898013164117200
of4593389801316999
patients.47173898013170122156179233293326369390
Pain51323898013165115138197
was32034048013179129169
the3396404801313189142
presenting3559404801316092144184237295327349406466
symptom4049404801313887177237269325415
in4488404801312077
70%45864048013154104185
patients47924048013161111143165217275307349
and51624048013150107167
recurrent3203419801313283132188219251302359390
UTI36134198013168119142
was37754198013179128167
present3962419801316091142182234291322
in4308419801311975
14%4403419801315399176
of4599419801315886
patients.47044198013161110141163215272303344364
Mean50874198013185138185242
console32034348013149105163203261284337
time3564434801313557146199
was37884348013179129169
8839824348013154107
min41144348013190112170
(36–153)4308434801313081133191237282332356
and46884348013151109169
blood4882434801316083141200261
loss5167434801312482122162
was32034498013179128167
in3393449801311976
all348844980131507193
patients36004498013160110141163214271303344
negligible.39634498013159111170192213271292351373425442
Crossing4424449801316393149188227248304363
vessels48074498013149100139179231253291
were51184498013178130160211
found3203464801312986144202261
in3488464801312684
66%35964648013156110190
of3813464801315887
patients.39274648013160110142164217275307348368
There43194648013154114167198250
were45964648013179131163214
no48374648013159117
intraop‑4979464801312583115146196255315350
erative3203479801315588140173197248302
complications35304798013159117210271296318369420454477537598639
in4194479801313392
this43124798013143103126167
group.45044798013170103162222284302
Postopera‑48324798013165123164201259321377410462497
tive3203494801313456105157
complications33844948013154110199259282303352401434456513572611
were40244948013179131163214
present4267494801316092144184237295327
in4618494801312785
447274948013158
cases48094948013154103143196236
(three5070494801313364122153205259
Clavien3203509801316385133181204256314
II3541509801313254
and36195098013158115175
one38185098013166125178
Clavien4020509801317193141189212264322
IIIb).436750980131315375134160175
The45665098013159119172
most47705098013190149189223
serious50185098013149102133156214272311
complication32035248013149105195254277299347397429451509567
was37985248013179129168
bleeding3994524801316184137190251272330389
from4407524801313366122212
a46435248013153
trokar4720524801313869126172223254
incision4998524801312784133154193215272331
that3203539801313493143176
required3404539801314193154213235267319381
surgical38095398013150108140199221270321344
intervention.4177539801313290123175207261314373405428486546566
Mean47765398013186140189248
follow5049539801313795119141200280
up32035548013158118
time3345554801313961149203
was35765548013180129169
15.337695548013159103120174
months.39725548013190148207239297336355
The43525548013155115168
success45445548013146102151197248289328
rate4896554801313887120171
(relief5091554801313362113136157210238
of3203569801315987
symptoms,3315569801314998189249282338428468487
improvement38265698013131120180212269318370459513571603
of4453569801316796
obstruction45735698013167127167202234293342378400458517
seen51145698013150103157215
on32035848013158116
scintigraphy,3339584801314189111168199221279310359418477522535
therefore3898584801313087140171222249306338389
no43075848013158116
need44435848013158111164224
for4691584801312581113
subsequent4824584801314096155195247307364416473505
surgery)3203599801314197129187240271323349
was35765998013180130169
98%37695998013154107187
of3980599801315987
cases.4092599801314998138191231251
Conclusion:33536143013565125188237265327373401462525550
Robot-assisted39276148013164122182241274303352391431453492526577638
pyeloplasty45896148013168116168190248309332380420455506
is5119614801313170
an52136148013158116
effective3203629801315381111163211247269318369
minimally35926298013189111168189277325347368416
invasive4031629801311976123172212232281332
method43836298013190142175232290350
for4756629801312582113
correction48896298013149104136168219268303325382440
of3203644801315987
ureteropelvic3318644801315890141174225257313374428450499522570
junction3912644801312885143191227250307366
obstruction.43066448013158119159193225283332368390448506525
It4855644801312861
is4940644801312766
usually5034644801315898154203225247295
associated3203659801315090130188238260308341392452
with36886598013179102136194
lasting3906659801313280120155177235295
resolution4225659801314092133191214271305327385444
of4693659801316795
obstruction48136598013166127167202234292341377400457516
in3203674801312381
most33086748013190148188223
of3555674801315887
the3666674801313492145
patients38356748013161111143165217275307349
KEY32047034014770134206
WORDS343770340147105189260345408
Robot-assisted,32037198013156114174233266294343383423444483518569629647
pyeloplasty,38747198013168116168190248308331380420454506519
obstruction,44177198013166126166201233291340376398455514532
uretero‑4973719801316698149182233265321356
pelvic32037348013161115137186209257
junction,3485734801312380138186223245302361379
hydronephrosis.38887348013159105163195251310363422481512569609630669689
………320376340147120240360