V09-09 UPDATED TIPS AND TRICKS FOR ROBOTIC ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY

Abstract

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-09 UPDATED TIPS AND TRICKS FOR ROBOTIC ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY John Richgels, Hernan Lescay, Brittany Adamic, and Mohan Gundeti John RichgelsJohn Richgels More articles by this author , Hernan LescayHernan Lescay More articles by this author , Brittany AdamicBrittany Adamic More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureterocalicostomy is an option for renal salvage in cases where conventional reconstructions have failed or as a primary option in anatomic situations such as intrarenal pelvis, malrotated, or horseshoe kidney. The primary principle of this procedure is to allow for dependent drainage. Ureterocalicostomy is often difficult due to extensive scar tissue and may be complicated by bleeding in the setting of a normal functioning lower pole cortex.. Identification of a dependent calyx and hemostasis can be difficult when there is a normal cortical thickness. We suggest some simple tips to avoid this step and optimize surgical results. We present our experience and updated technical tips with robotic-assisted laparoscopic ureterocalicostomy and provide a step-by-step video. METHODS: Five patients underwent robotic-assisted laparoscopic ureterocalicostomy between the years 2012 and 2021 by a single surgeon. Perioperative outcomes measured included operative time, hospital stay, pain relief, degree of hydronephrosis on postoperative ultrasound at 3 months, and renal scintigraphy as needed. We describe the operative procedure and provide tips on identifying a dependent lower pole calyx, the use of harmonic scalpel for incision of the lower pole cortex, and anastomosis by pre-placement of interrupted sutures as the urothelium of the renal calyces is thin and friable. RESULTS: Four of five patients had one prior pyeloplasty, and one patient had two prior pyeloplasties. Mean operative time (incision to closure) was 208 minutes. No Clavien-Dindo 30-day complications were encountered and no patients required blood transfusion. Long term follow up was available for four out of five patients. Anatomic success was reported those four patients with a mean follow-up of 4.46 years; however, one out of the four patients with long term follow up ultimately required nephrectomy despite patent anastomosis, which would not drain due to a capacious pelvis. CONCLUSIONS: Robotic-assisted laparoscopic ureterocalicostomy is feasible in re-operative cases with extensive scaring and in patients with abnormal renal anatomy. We offer tips to allow for safe and proficient performance of this procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e690-e690 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Richgels More articles by this author Hernan Lescay More articles by this author Brittany Adamic More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement Loading ...