Robot-assisted laparoscopic buccal mucosa replacement for ureteroplasty in the treatment of complex upper ureteral strictures

Abstract

Objective To discuss the feasibility, safety and efficacy of robot-assisted laparoscopic buccal mucosal ureteroplasty in the treatment of long segment upper ureteral stricture. Methods Five patients with complex ureteral strictures were treated with robot-assisted laparoscopic buccal mucosa ureteroplasty (5 males; right side, 2 cases; left side, 3 cases)in our hospital from March to July of 2017. The patients aged 25-40 years with median of 35 years old. The median body mass index was 23.5 kg/m2(19-29 kg/m2). Data of surgical conditions, postoperative complications, and follow-up were collected. Results All patients were treated with robot-assisted laparoscopic buccal mucosa ureteroplasty and the operations were uneventful. The median length of stricture of upper ureter were 3 cm (2-6 cm). The median operation time was 360 min (200-400 min), median blood loss was 100 ml(50-200 ml), drainage tube retained time was 5 d(2-9 d) , post-operative hospital stay was 11 d(7-12 d), and the median creatinine value was 85 μmol/L (76-98 μmol/L). No urine leakage, infection, buccal mucosa necrosis or other serious complications occurred after surgery. Five patients’ CT examnation showed improved hydronephrosis 3 weeks post-operatively. DJ stent was removed 3 months after surgery in 2 patients, and 1 patient presented with no hydronephrosis, another one with mild hydronephrosis. DJ stent was removed 6 months after surgery in the other 3 patients with improved hydronephrosis. Conclusions Robot-assisted laparoscopic buccal mucosal ureteroplasty for the treatment of long segment upper ureteral stricture is a safe and feasible procedure, with a good short-term effectiveness and without severe complications. Key words: Buccal mucosa; Ureteral stricture; Robot; Laparoscopy