Abstract
ABSTRACTPurpose:The robot-assisted approach to distal ureteral reconstruction is increasingly utilized. Traditionally, the robot is docked between the legs in lithotomy position resulting in limited bladder access for stent placement. We examined the use of side docking of the daVinci robot® to perform distal ureteral reconstruction.Materials and Methods:A retrospective review of distal ureteral reconstruction (ureteral reimplantation and uretero-ureterostomy) executed robotically was performed at a single institution by a single surgeon. The daVinci robotic® Si surgical platform was positioned at the right side of the patient facing towards the head of the patient, i.e. side docking.Results:A total of 14 cases were identified from 2011–2013. Nine patients underwent ureteral reimplantation for ureteral injury, two for vesicoureteral reflux, one for ureteral stricture, and one for megaureter. One patient had an uretero-ureterostomy for a distal stricture. Three patients required a Boari flap due to extensive ureteral injury. Mean operative time was 286 minutes (189–364), mean estimated blood loss was 40cc (10–200), and mean length of stay was 2.3 days (1–4). Follow-up renal ultrasound was available for review in 10/14 patients and revealed no long-term complications in any patient. Mean follow-up was 20.7 months (0.1–59.3).Conclusion:Robot-assisted laparoscopic distal ureteral reconstruction is safe and effective. Side docking of the robot allows ready access to the perineum and acceptable placement of the robot to successfully complete ureteral repair.
Highlights
Laparoscopic techniques for ureteral reimplantation and reconstruction continue to grow
The position of a robotic-assisted laparoscopic ureteral reimplantation is described by placing the patient in lithotomy position followed by steep Trendelenberg position and the robot is docked between the patient’s legs
Ureteral reconstruction can be accomplished using a variety of open procedures and has been described in the urologic literature with excellent long-term outcomes
Summary
Laparoscopic techniques for ureteral reimplantation and reconstruction continue to grow. With the introduction of the daVinci Surgical System® (Intuitive Surgical, Sunnyvale, CA) minimally invasive surgery has allowed surgeons to accomplish increasingly complex procedures with a shorter learning curve and better efficacy [4]. The position of a robotic-assisted laparoscopic ureteral reimplantation is described by placing the patient in lithotomy position followed by steep Trendelenberg position and the robot is docked between the patient’s legs. This position, results in limited access to the bladder for retrograde placement of a ureteral stent. We present an alternative docking position which simplifies surgical set-up, allows ready access to the bladder for stent placement and may lead to shorter operating time without compromising surgical technique
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