* The child was suffering from a blockage in urine flow (PUJ Obstruction) in one kidney and backward flow of urine (Grade IV Vesicoureteral Reflux) in the other; both conditions were successfully treated in a single surgical session at ApolloMedics Lucknow.

TIL Desk Lucknow:👉 The Urology team at ApolloMedics Super Speciality Hospital, Lucknow, has achieved a significant milestone by successfully treating two distinct and complex congenital conditions affecting both kidneys of a seven-year-old girl in a single robotic surgical session, marking the first such procedure in India. The child's right kidney was affected by Pelvi-Ureteric Junction (PUJ) Obstruction, a condition that blocks the normal flow of urine from the kidney. Meanwhile, the left kidney had Grade IV Vesicoureteral Reflux (VUR), a condition in which urine flows backwards from the urinary bladder towards the kidney.

The surgery was performed under the leadership of Dr. Givi Gaurav, Associate Director and Unit Head, Urology, Uro-Oncology and Kidney Transplant.

The child had been experiencing recurrent Urinary Tract Infections (UTIs) since the age of two to three years. Despite receiving treatment at different healthcare facilities, the infections continued to recur. Subsequently, she developed pain on the right side of her abdomen and flank, accompanied by nausea, following which she was brought to ApolloMedics for further evaluation.

Detailed investigations revealed PUJ obstruction in the right kidney, along with a lower-pole crossing vessel. This meant that a blood vessel passing near the lower portion of the kidney was contributing to the obstruction of urine flow. On the other hand, an MCUG investigation confirmed Grade IV VUR in the left kidney, a severe condition in which urine flows backwards towards the kidney.

Dr. Gyvi Gaurav, Associate Director and Unit Head, Urology, Uro-Oncology and Kidney Transplant said, "The uniqueness of this case was not merely that both procedures were performed with robotic assistance. The child had two different conditions affecting both kidneys, each requiring a separate reconstructive procedure. The challenge was to safely address both conditions under a single anaesthesia and in one robotic surgical session, without creating any additional surgical access points in the abdomen."

He further added, "In the published medical literature available to us, we could not find any previous description of this specific combination. It involved robotic pyeloplasty for PUJ obstruction on one side and ureteric reimplantation for severe VUR on the other, performed during the same surgical session. This makes it an unusual robotic reconstructive procedure from both clinical and technical perspectives."

A DTPA scan revealed that the right kidney was contributing approximately 40% of the overall renal function, while the left kidney was contributing around 60%. The challenge before the doctors was that the left kidney, despite functioning better, had severe reflux and a history of recurrent infections, while the right kidney had a significant obstruction to urine flow. Since the two kidneys had different conditions requiring separate surgical procedures, the medical team decided to treat both in a single surgical session.

During the robotic surgery, the doctors first performed an Anderson-Hynes Pyeloplasty to correct the obstruction in the right kidney. In this procedure, the obstructed portion of the PUJ was removed and reconstructed to restore the normal flow of urine. The crossing vessel was carefully preserved during the surgery. The renal pelvis, where urine collects before flowing into the ureter, was repositioned anterior to the blood vessel to relieve the obstruction.

Following this, the robotic system was undocked, and the child's surgical position was changed to facilitate treatment of the other kidney. No additional abdominal port was required for the second procedure. Instead, the existing port in the left iliac fossa (the lower-left region of the abdomen) was enlarged from 5 mm to 8 mm. The robotic system was then docked again.

The second procedure involved Extravesical Ureteric Reimplantation to correct the condition in the left kidney. In this procedure, the ureter is repositioned and reconnected to the urinary bladder in a manner that prevents urine from flowing backwards towards the kidney. This successfully addressed the Grade IV reflux in the left kidney.

The entire procedure was completed through five port sites in a single continuous robotic surgical session. No additional port was required, and robotic re-registration was not needed between the procedures. The total console time was approximately 323 minutes, with surgical instruments actively engaged for 261 minutes. The estimated blood loss was around 50 ml. There was no need to convert the procedure into open surgery, and no intraoperative complications were reported. The child was discharged from the hospital on the third day after surgery.

During the one-month follow-up, the child had not developed any new UTI. Postoperative ultrasonography findings were normal. The DTPA scan also showed no evidence of obstruction to urine flow in the right kidney. The ureteric stents, small tubes placed after surgery to help maintain the flow of urine, were successfully removed at the one-month follow-up. The child's recovery was satisfactory.

This surgery marks the first robotic reconstructive procedure of its kind in India, in which two separate surgical procedures were performed in a single robotic surgical session to address two different congenital conditions affecting both kidneys.

Dr. Mayank Somani, MD & CEO, ApolloMedics Super Speciality Hospital, said, "Timely identification of congenital urinary tract conditions in children and seeking treatment from specialists are extremely important. In this case, the medical team successfully treated two different conditions affecting both kidneys through a single minimally invasive robotic procedure. This reflects the expertise of our multidisciplinary team and the advanced capabilities available at ApolloMedics for complex robotic urological reconstruction."

The surgical team is preparing to present this case at a specialised robotic surgery conference and submit it for publication in medical literature.