Investig Clin Urol.  2020 Feb;61(Suppl 1):S23-S32. 10.4111/icu.2020.61.S1.S23.

Robot-assisted distal ureteral reconstruction for benign pathology: Current state

• Asghar AM
• Lee RA
• Yang KK
• Metro M
• Eun DD

• KMID: 2469123
• DOI: http://doi.org/10.4111/icu.2020.61.S1.S23

Abstract

Distal ureteral reconstruction for benign pathologies such as stricture disease or iatrogenic injury has posed a challenge for urologist as endoscopic procedures have poor long-term outcomes, requiring definitive open reconstruction. Over the past decade, there has been an increasing shift towards robot-assisted laparoscopy (RAL) with multiple institutions reporting their outcomes. In this article, we reviewed the current literature on RAL distal ureteral reconstruction, focusing on benign pathologies only. We present peri-operative data and outcomes on the most common technique, ureteral reimplantation, as well as adjunct procedures such as psoas hitch and Boari flap. Additionally, we present alternative techniques reported in the literature with some technical considerations. Lastly, we describe the outcomes of the comparative studies between open, laparoscopy, and RAL. Although the body of literature in this field is limited, RAL reconstruction of the distal ureter appears to be safe, feasible, and with some advantages over the traditional open approach.

Keyword

Reconstructive surgical procedures; Robotics; Ureter; Ureteral obstruction

MeSH Terms

Constriction, Pathologic
Laparoscopy
Pathology*
Reconstructive Surgical Procedures
Replantation
Robotics
Ureter*
Ureteral Obstruction

Figure

• 

  Fig. 1 Ureteral stricture bypass surgery with appendiceal graft [35]. UO, ureteral orifice.

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  Fig. 2 Port placement for robotic distal ureteral reconstruction [32]. Ports 3 & 5 may be avoided per surgeon's discretion.

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  Fig. 3 Side-docking for distal ureteral reconstruction (photo and port placement diagram) [18].

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