In a landmark achievement for robotic urology, a team of specialists in Pune has successfully carried out the world’s first combined robotic surgery using a buccal mucosal graft to repair an ectopic pelvic kidney. The innovative single-stage procedure addressed multiple complications at once, including severe ureter obstruction and multiple kidney stones.
The surgical breakthrough — which merged assisted laparoscopic pyelolithotomy with buccal mucosal graft pyeloplasty — has been formally reported as the first documented case of its kind in the Journal of Robotic Surgery on October 30.
The patient had been suffering from chronic abdominal pain due to several stones lodged at the kidney–ureter junction. According to Dr. Suresh Patankar, chairperson of Ace Hospital, the underlying anatomy made treatment particularly challenging.
“The patient’s kidney was situated deep within the pelvis, accompanied by a short ureter, abnormal blood vessels, and multiple stones obstructing the junction. Conventional treatment had proven ineffective,” he explained.
The atypical location of the kidney, coupled with inflamed tissues and proximity to the intestines, made the procedure especially high-risk. Senior urologist Dr. Gururaj Padasalagi noted that extensive scarring from long-standing stones further complicated the repair:
“In such scenarios, tissues can easily tear, resulting in bleeding or infection. Previous guidelines recommended a two-stage surgery — however, robotic technology enabled us to accomplish it safely in a single procedure.”
Urologist Dr. Sachin Bhujbal highlighted that robotic assistance allowed the team to simultaneously extract stones and reconstruct the narrowed segment of the ureter using tissue harvested from the patient’s cheek — a strategy rarely considered for such anatomically complex cases due to the absence of established protocols.
Dr. Saurabh Uplenchwar, who was also part of the team, confirmed that the patient recovered swiftly and was discharged within four days. Follow-up evaluations showed excellent healing and no signs of obstruction.
This pioneering surgery marks a major step forward in expanding the possibilities of robotic intervention for rare congenital kidney conditions and complex urological reconstructions.