V09-12 INTRACORPORAL ROBOTIC LEFT ILEAL URETER REPLACEMENT: A STEP-BY-STEP GUIDE

Abstract

You have accessJournal of UrologyCME1 Apr 2023V09-12 INTRACORPORAL ROBOTIC LEFT ILEAL URETER REPLACEMENT: A STEP-BY-STEP GUIDE Devin Boehm, Jonathan Rosenfeld, Emily Ji, and Ziho Lee Devin BoehmDevin Boehm More articles by this author , Jonathan RosenfeldJonathan Rosenfeld More articles by this author , Emily JiEmily Ji More articles by this author , and Ziho LeeZiho Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intracorporal robotic left ileal ureter replacement is a technically challenging procedure. Only a handful of reports exist in the literature. We describe our approach for intracorporal robotic left ileal ureter replacement and highlight key aspects of our surgical technique. METHODS: We demonstrate our technique on a 49-year-old woman with a 25-centimeter left pan-ureteral obliteration secondary to endoscopic stone surgery. Our technique involves five major steps: proximal ureteral dissection, bowel harvest, bladder dissection, distal anastomosis, and proximal anastomosis. In order to optimize access to the upper and lower urinary tracts, we use two distinct patient positions and port placement schemas based on the field of interest. Tilting the bed allows for toggling between the modified flank (upper tract) and modified supine positions (lower tract) without the need to reposition or redrape the patient. During reconstruction, the ileal ureter may be brought over to the left side by tunneling only the proximal segment or by tunneling the entire segment of ileum (Figure 1). RESULTS: For our index case, operative time was 340 minutes, estimated blood loss was 200 milliliters, and length of stay was 5 days. There were no 90-day major postoperative complications. Renal scan obtained at 4 months postoperatively demonstrated a T1/2 of 14 minutes. At 8 months follow-up there was no evidence of stricture recurrence. CONCLUSIONS: Intracorporal robotic left ileal ureter replacement is a reproducible technique for the management of pan-ureteral stricture disease. Adhering to a system and simplifying the technique into five steps may facilitate successful completion of this challenging procedure. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e840 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Devin Boehm More articles by this author Jonathan Rosenfeld More articles by this author Emily Ji More articles by this author Ziho Lee More articles by this author Expand All Advertisement PDF downloadLoading ...