2958 Robotic Ureteral Reimplantation for Posthysterectomy Injury: Is Laparotomy Necessary

Abstract

Study Objective There is limited data on robotic ureteral reimplantation for ureteral injury following hysterectomy. The aim of this study is to demonstrate the use of robotic ureteral reimplantation in a setting of ureteral injury sustained during hysterectomy. Design Retrospective case series Setting Hospital Patients or Participants Patients who developed ureteral obstruction as a result of hysterectomy Interventions Robotic ureteral implantation Measurements and Main Results This case series exhibited a 100% rate of success of robotic ureteral reimplantation without conversion from robotic to an open procedure. Two patients presented with injury in bilateral ureters (unilateral ureteral reimplantation with contralateral stenting), 4 with injury on the left, and 3 with injury on the right, 1 bilateral. 2 of the 8 procedures had a history of concurrent bladder injury during the initial surgery. The mean days to the recognition of ureteral injury was 6.5 days. 37.5% underwent concomitant lysis of adhesions during the robotic ureteroneocystostomy. The Jackson-Pratt drain, ureteral stents, and foley catheters remained upon discharge and were removed in the office post-operatively. JP drains were removed on ave 8.5 (8-10) days. Foley catheters were removed on 10.8 average (6-18) days. Ureteral stents were removed mean 34 (28-47) days. All patient underwent serial outpatient Renal US post-operatively with only 25% of patients exhibiting mild hydronephrosis following ureteral reimplantation and ureteral stent removal. 0% of patient required surgical revision of the ureteroneocystostomy. Mean duration of post-operative follow up was 110.75 (22-270) days. Conclusion The use of robotic ureteral reimplantation is effective and safe and is underutilized. This case series demonstrates effective utilization of robotics in ureteroneocystostomy following ureteral injury sustained during hysterectomy without the need of surgical revision of the ureteroneocystostomy post-operatively, no loss of renal units, and no significant hydronephrosis.