Complex robotic lower urinary tract surgeries in patients with previous open surgery

Abstract

PurposeWe describe our experience with robot assisted complex lower urinary tract reconstruction (CUTR) in patients with previous open abdominal surgery (PAS). Materials and MethodsPatients with any PAS undergoing robot assisted CUTR were included. CUTR was defined as bladder neck reconstruction (BNR) or continent catheterizable conduits (CCC) or both, redo surgery at the bladder neck for persistent incontinence, or any of the above with an antegrade enema channel creation (MACE). Ureteral and renal surgeries were excluded. Patient demographics, surgery performed, operative techniques, operative times and outcomes were assessed. Results36 patients met inclusion. 21 patients had multiple laparotomies for ventriculoperitoneal (VP) shunt revisions. 15 had laparotomy with other adjunct procedures in 14 and laparotomy with colostomy in 1. There were no access injuries and 5 conversions. Mean operative time was 8.2 hrs (4-12 hrs). Mean length of stay (LOS) was 74.9 hrs (23-216 hrs). The first 18 cases took longer than the last 18 cases (mean 9.1 hr vs mean 7.5 hr p= 0.002). Patients with multiple VP shunt revisions had higher conversion rates and higher mean operative times when compared to other patients (p=0.01 and p=0.002 respectively). Patients with multiple VP shunt revisions had longer LOS when compared to other patients (p= 0.02). ConclusionsRobot assisted CUTR in patients with PAS is safe and feasible. Longer operative times should be expected early in a surgeon’s experience. Multiple VP shunt revisions have higher conversion rates and longer operative times when compared to other indications for previous surgery.