Korean J Urol.  2013 Aug;54(8):516-521. 10.4111/kju.2013.54.8.516.

Single-Surgeon Experience With Robot-Assisted Ureteroneocystostomy for Distal Ureteral Pathologies in Adults

• Lee Z
• Sehgal S
• Llukani E
• Reilly C
• Doumanian
• Mydlo J
• Lee DI
• Eun DD

• KMID: 1840463
• DOI: http://doi.org/10.4111/kju.2013.54.8.516

Abstract

PURPOSE
To demonstrate our technical approach for robot-assisted ureteroneocystostomy (R-UNC) for benign and malignant distal ureteral pathologies.
MATERIALS AND METHODS
Between January 2009 and January 2013, a total of 10 patients underwent R-UNC in the distal ureter by a single surgeon. Indications for R-UNC were as follows: idiopathic (3), fistula (2), iatrogenic (2), malignancy (2), and chronic vesicoureteral reflux (1).
RESULTS
Tension-free anastomosis was attained in all 10 R-UNC procedures. A psoas hitch was performed in 6/10 cases (60%). Intravesical and extravesical reimplantations were completed in 5/10 (50%) and 5/10 cases (50%), respectively. A nonrefluxing ureter was constructed in 2/10 cases (20%). The patients' mean age was 52.9+/-16.6 years, their mean body mass index was 30.8+/-6.3 kg/m2, the mean operative time was 211.7+/-69.3 minutes, mean estimated blood loss was 102.5+/-110.8 mL, and mean length of stay was 2.8+/-2.3 days. There were no intraoperative complications. There was one Clavien-Dindo grade I and one Clavien-Dindo grade II postoperative complication. The mean postoperative follow-up duration was 28.5+/-15.5 months. Two patients had recurrence of ureteral strictures at 3 months postoperatively and were managed successfully with balloon dilation.
CONCLUSIONS
Our technique for R-UNC demonstrates good perioperative outcomes. However, underlying periureteral inflammation and pelvic adhesions may predispose patients for stricture recurrence after R-UNC.

Keyword

Minimally invasive surgical procedures; Reconstructive surgical procedures; Ureter

MeSH Terms

Adult
Body Mass Index
Constriction, Pathologic
Fistula
Follow-Up Studies
Humans
Inflammation
Intraoperative Complications
Length of Stay
Operative Time
Postoperative Complications
Reconstructive Surgical Procedures
Recurrence
Replantation
Surgical Procedures, Minimally Invasive
Ureter
Vesico-Ureteral Reflux

Figure

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  FIG. 1 Port placement.

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  FIG. 2 Gastro-epiploic flap.

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