10 ROBOTIC MANAGEMENT OF BENIGN MID AND DISTAL URETERAL STRICTURE DISEASE: RETROSPECTIVE COMPARISON TO LAPAROSCOPIC APPROACHES AT A SINGLE INSTITUTION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 201210 ROBOTIC MANAGEMENT OF BENIGN MID AND DISTAL URETERAL STRICTURE DISEASE: RETROSPECTIVE COMPARISON TO LAPAROSCOPIC APPROACHES AT A SINGLE INSTITUTION Kevin Baldie, Jordan Angell, Kenneth Ogan, Nedra Hood, and John Pattaras Kevin BaldieKevin Baldie Atlanta, GA More articles by this author , Jordan AngellJordan Angell Atlanta, GA More articles by this author , Kenneth OganKenneth Ogan Atlanta, GA More articles by this author , Nedra HoodNedra Hood Atlanta, GA More articles by this author , and John PattarasJohn Pattaras Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.052AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral stricture disease has been treated via various surgical approaches. Open repair has traditionally been the gold standard for strictures refractory to endourologic methods. Recent work has shown the efficacy of laparoscopic techniques. We hypothesize that robotic ureteral stricture reconstruction is as effective as laparoscopy. METHODS In an IRB approved retrospective study, 16 patients underwent robotic mid and distal ureteral reconstruction (13 ureteral reimplantations, 3 ureteroureterostomies) at our institution from August 2008 to September 2011. Proximal ureteral stricture, extrinsic obstruction and ureteropelvic junction (UPJ) obstruction cases were excluded. Demographics, perioperative and postoperative data were reviewed and compared to laparoscopic outcomes from our previously published laparoscopic series at the same institution. RESULTS Fourteen of 16 procedures were performed completely robotically in the robotic group. There were two open conversions for Boari flap reconstruction and reimplantation with psoas hitch, respectively. A grade IIIb Clavien complication occurred involving an intraoperative bowel injury requiring additional surgery. By comparison, 5 of 6 procedures in the laparoscopic group were performed completely laparoscopically, with one patient undergoing an elective open conversion to complete the reimplantation. A grade II Clavien complication involving postoperative fevers occurred and was treated via oral antibiotics. Table 1 illustrates outcomes for total robotic, robotic reimplantation (RI), robotic ureteroureterostomy (UU), and laparoscopic reimplantation (RI) groups. All cases were clinically and radiographically successful to date. Data± Total Robotic Robotic RI Robotic UU Laparoscopic RI Demographic n = 16 n = 13 n = 3 n = 6 Age (years) 44(40;23-77) 42(39;23-77) 53(51;51-57) 56(53;35-79) BMI (kg/m2) 28.5(28.1;17.8-42.3) 28.4(27.8;17.8-42.3) 28.8(28.4;20.4-37.7) 27.2(27.1;21.6-32.9) Perioperative Operative Time (minutes) 258.6(252.0;146-450) 266.7(275.0;146-450) 223.0(207.0;168-294) 276.5(277.5;180-360) EBL (mL) 171(100;30-500) 187(100;30-500) 100(100;50-150) 150(175;50-250) LOS (days) 2.5(2;1-8) 2.8(2;1-8) 1.3(1;1-2) 2.7(2;2-5) Complications⁎ IIIb (1) IIIb (1) None II (1) Conversions 2 2 0 1 Postoperative F/U Time (months) 5.4(3.9;1-14) 3.9(2.5;1-12) 11.8(12.3;10-14) 13.2(9.5;2-33) Success C, R: 100 C, R: 100 C, R: 100 C,R: 100 ± Presented as mean (median; range); BMI = body mass index; EBL = estimated blood loss; LOS = length of stay; F/U = follow-up; C = Clinical Success; R = Radiographic Success ⁎ Clavien Classification Grade (events). CONCLUSIONS Though early in our experience, robotic repair of mid and distal ureteral strictures appears to be an efficacious approach for ureteral obstruction. The robotic method may offer additional benefits including improved visualization and technical capacity. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e4 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Baldie Atlanta, GA More articles by this author Jordan Angell Atlanta, GA More articles by this author Kenneth Ogan Atlanta, GA More articles by this author Nedra Hood Atlanta, GA More articles by this author John Pattaras Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...