Robotic-Assisted Repair of Ureteroenteric Strictures after Cystectomy with Urinary Diversion: Technique Description and Outcomes from the ERUS Scientific Working Group.

Abstract

Robotic-assisted repair of benign ureteroenteric anastomotic strictures (UAS) provides an alternative to the open approach. We aimed to report short-, medium-, and long-term outcomes for robotic repair of benign UAS, and to provide a detailed video demonstration of critical operative techniques in performing this procedure robotically. Between January 2013 and September 2022, 31 patients from 7 institutions who previously underwent radical cystectomy and subsequently developed UAS underwent robotic repair of UAS. Perioperative variables were prospectively collected, and postoperative outcomes were assessed. The surgery starts with a lysis of adhesions after previous surgery. Ureters are dissected, and the level of the stricture is identified. The ureter is then divided, and the stricture is resected. Finally, the ureter is spatulated and reimplanted with Nesbit technique after stenting with double-J stents. In cases where both ureters show strictures, Wallace technique for reimplantation can be applied. After robotic or open cystectomy, 31 patients had a total of 43 UAS at a median (IQR) follow-up of 21 (9-43) months. Median stricture length (cm) was 2.0 (1.0-3.25), operative duration (min) was 141 (121-232), estimated blood loss (mL) was 100 (50-150), and length of hospital stay (days) was five (3-9). One (3.2%) case was converted to open and one (3.2%) intraoperative complication occurred. Seven (22.6%) patients experienced postoperative complications, including four (12.9%) Clavien-Dindo grade 3 complications. No Clavien-Dindo grade 4 or 5 complications occurred. Stricture recurrence occurred in 2 (6.5%) patients. These results demonstrate that robotic repair of UAS is feasible and effective approach with outcomes in line with prior open series.