Intracorporeal Antegrade and Retrograde Stenting During Robot-Assisted Urinary Tract Reconstruction: Is It the Ideal Choice?

Abstract

Introduction and Objective: One of the pertinent steps in many urologic reconstructive procedures is the placement of a stent across the repair. With regard to upper urinary tract reconstruction, many surgeons perform this step cystoscopically and place the stent in a retrograde fashion. Herein, we present our simplified, efficient, and cost-saving technique of Double-J (JJ) stent placement intracorporeally during robot-assisted upper urinary tract reconstructive surgery. Methods: With Institutional Review Board's approval, we queried our database of robotic procedures to identify those reconstructive operations that involved intracorporeal JJ stent placement since 2008. We describe our step-by-step technique for intracorporeal JJ stent placement during robot-assisted pyeloplasty, pyelolithotomy, and upper, mid, and lower ureteral reconstructive surgeries. Briefly, the floppy tip of a guide wire is passed through the open end of the JJ stent until it straightens out the stent. After a certain amount of the reconstruction has been performed, the stent is advanced intracorporeally through the assistant port. The console surgeon utilizes the robotic instruments to manipulate the stent into the ureter or other desired location. Once the stent has been adequately placed, it is stabilized with the robotic instruments while the guide wire is removed. A variety of techniques are employed for specific reconstructions to manipulate the stent into the desired position. Results: In the last 3 years, we have used this approach in 150 patients. Mean time of insertion was ∼3.5 minutes. In 3 patients, postoperative kidney, ureter, and bladder radiograph demonstrated that the stent had migrated proximally into the ureter. As these patients did not have any discomfort and the stent still spanned across the reconstructed anastomosis, we chose not to reposition the stent. In these 3 patients, the stent was removed ureteroscopically at the appropriate time, without any sequela. Conclusions: The described intracorporeal stenting technique during robotic urologic reconstructive procedures is efficient, cost-effective, and relatively simple to master. There is no need for patient repositioning, cystoscopy, or fluoroscopy, thereby avoiding increased operative time, cost, and radiation exposure. In upper tract robotic reconstructive surgery, intracorporeal JJ stenting should be the ideal choice. No competing financial interests exist. Runtime of video: 6 mins 27 secs