NYU Technique for Robot-Assisted Boari Flap

Abstract

Introduction and Objective: Robot-assisted laparoscopic techniques are being adopted by urologists for reconstruction of the upper urinary tract. Specifically, this technique is being increasingly used to manage complex ureteral strictures. In this video, we demonstrate the use of robotic technology to repair a proximal ureteral stricture utilizing a boari flap. Methods: Utilizing all of the principles of open surgery, we created a minimally invasive technique to perform a robot-assisted boari flap. Using a high-definition recording system and iMovie software with narrative and annotative editing, we created a video outlining the pertinent steps of this procedure. We review and present our data from a retrospectively collected cohort of patients undergoing robot-assisted ureteral reimplant. Results: Between 2005 and 2012, we performed a total of 23 robot-assisted ureteral reimplants of which 13% were boari flaps. Average age was 65. There were 11 females and 12 males. Average body mass index (BMI) was 27.4. Of the 23, 11 were right reimplants, 12 were left-sided, none were bilateral and 10 had previous repairs. Average operative time was 271.4 minutes. Average length of stay (LOS) was 2.3 days. There were 3 complications—a lower extremity neuropathy secondary to positioning, a stent migration, and an inadvertent enteromy. Average follow-up was 6.4 months. Symptom resolution as assessed by radiology was 94.7% and clinical symptom resolution at most recent follow up was 100%. Conclusion: The use of robot-assisted surgery provides a safe, reproducible, and durable technique to manage even the most complex upper urinary reconstructive procedures. This video illustrates many of the advantages provided by the use of robotics and how the open surgical technique can be reproduced in a minimally invasive environment. No competing financial interests exist. Runtime of video: 7 mins 31 secs