V4-11 STEP-BY-STEP ROBOTIC URETEROURETEROSTOMY: TIPS AND TRICKS TO OPTIMIZE OUTCOMES

Abstract

You have accessJournal of UrologyRobotics – Prostate/Novel Imaging1 Apr 2015V4-11 STEP-BY-STEP ROBOTIC URETEROURETEROSTOMY: TIPS AND TRICKS TO OPTIMIZE OUTCOMES Hiury Andrade, Jihad Kaouk, Homayoun Zargar, Peter Caputo, Jayram Krishnan, Oktay Akca, Daniel Ramirez, Luis Felipe Brandao, Georges-Pascal Haber, and Robert Stein Hiury AndradeHiury Andrade More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Peter CaputoPeter Caputo More articles by this author , Jayram KrishnanJayram Krishnan More articles by this author , Oktay AkcaOktay Akca More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Luis Felipe BrandaoLuis Felipe Brandao More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.723AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mid/proximal ureteral stricture is a complex disease with few treatment options. Ureteroureterostomy is a challenging technique utilized to manage cases not amenable to endoscopic treatment or ureteroneocystostomy. The robotic approach is technically feasible and utilizes the same principles of open ureteral reconstruction. We demonstrate the step-by-step operative technique with emphasis on key steps that are useful to achieve a tension-free anastomosis. METHODS The surgery depicts a 27 year old female with a history of left mid ureteral stone who underwent rigid ureteroscopy and laser lithotripsy for an impacted stone. After stent removal, patient had subsequent pain requiring several secondary procedures. A retrograde pyelogram revealed a 5 mm length stricture in the mid left ureter. The robotic ureteroureterostomy was performed using the following steps: Key step 1: The patient is placed in 60° modified flank position. The table is not flexed as this may place tension on the eventual anastomosis. The ipsilateral arm is positioned on the side of patient, so the robot will not have any clashing with it while performing distal ureter. Key step 2: All ports are placed in a straight-line configuration as this allows for unobstructed distal ureteral dissection. Key step 3: The robot is then docked at a 90° angle, perpendicular to the patient. This configuration allows versatility with proximal and distal dissection of the ureter. Key Step 4: The transection must be done directly on the strictured segment. This will ensure that healthy ureteral tissue is not compromised during transection of the affected area. Key step 5: After spatulating the ureteral ends, the proximal and distal ureter are brought into close apposition with at least 2 peri-ureteral sutures. This allows for a tension-free mucosal anastomosis. RESULTS In total, 6 patients have undergone robotic ureteroureterostomy. All cases were successful and no patient has required additional procedures. Ipsilateral urine drainage and renal function have improved or remained stable as assessed by diuretic renal scintigraphy for all patients. No radiographic or symptomatic recurrence has been noted in the follow up period over two years. CONCLUSIONS Ureteroureterostomy using a robotic technique is a feasible and effective surgery, which follows standardized principles in ureteral reconstruction. The demonstrated technique with key steps can simplify this challenging procedure and make it more reproducible. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e407 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiury Andrade More articles by this author Jihad Kaouk More articles by this author Homayoun Zargar More articles by this author Peter Caputo More articles by this author Jayram Krishnan More articles by this author Oktay Akca More articles by this author Daniel Ramirez More articles by this author Luis Felipe Brandao More articles by this author Georges-Pascal Haber More articles by this author Robert Stein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...