Open Ureteral Surgery Research Articles

Robot-assisted laparoscopic ureteral reconstruction: а systematic review of literature.

IntroductionTo review the literature, as well as to analyze and compare available data on robot-assisted laparoscopic (RAL) surgery versus open surgery, carried out in ureteral reconstructions in terms of different surgical characteristics.Materials and methodsEligible studies, published between 1997 and July 2016, were retrieved through MEDLINE by applying predetermined inclusion and exclusion criteria with the English language restriction. Publications on RAL surgeries, carried out in different ureteral reconstructions and of any study design, including case series and comparative studies, were included. The study was performed in accordance with the PRISMA statement.ResultsA total of 12 retrospective studies (case series and comparative studies) met the systematic review selection criteria involving 245 RAL and 76 open ureteral surgery cases. Main indications for ureter reconstruction were strictures, tumors and injuries. The individual results of comparative studies revealed that the EBL was statistically significantly lower for RAL than for open surgery. As for operation time, length of hospital stay and follow-up time, the data was contradictory. The rate of recurrent stricture in RAL and open groups was similar: -9.0%. The meta-analysis of three comparative studies confirmed that patients lose statistically significantly less blood in RAL, compared to open surgery.ConclusionsThe analysis of limited data available shows that robot-assisted laparoscopic ureteral reconstruction is a safe and effective minimally invasive technique with high cure rates similar to those of the conventional open approach and, with favorable safety profile. Future well-designed randomized controlled trials are required to strengthen our findings.

Techniques for Laparoscopic and Robotic Localization of Intraluminal Ureteral Pathology

Improvements in endoscopic technology have made open ureteral surgery uncommon. There remain cases of ureteral disease not amenable to ureteroscopic treatment, but laparoscopy allows even these complicated cases to be treated in a minimally invasive fashion. Laparoscopic and robotic surgical treatment of the ureter requires the ability to localize the diseased segment laparoscopically, even when the defect is within the lumen and cannot be seen externally or palpated as in open surgery. We describe 3 techniques to localize the disease within the ureter during laparoscopy and robotic surgery and the benefits and limitations of each technique. Three cases of laparoscopic and robotic ureteral surgery illustrate 3 different techniques used to localize disease within the ureteral lumen. The first case illustrates a ureteral occlusion balloon catheter used to identify a stricture by distending the collecting system proximal to the obstruction and cinching the balloon against the stricture. The second case illustrates a flexible ureteroscope introduced through a 5-mm port and into the incised ureter to guide excision of extensive polyposis. The third case, involving a polyp and stricture, illustrates a technique involving retrograde ureteroscopy with "cutting to the light" laparoscopically. Three techniques are demonstrated to successfully localize intraluminal ureteral disease that could not be identified visually by laparoscopic inspection alone. These techniques also can minimize the extent of ureteral dissection to preserve blood supply. Laparoscopy and robotic surgery can be successfully applied to benign ureteral disease not amenable to ureteroscopic treatment. Three cases are presented to illustrate 3 techniques for laparoscopic or robotic localization of intraluminal ureteral disease.

VID-03.06: Laparoscopic ureterolithotomy: a transition from transperitoneal to retroperitoneal approach

Laparoscopic retroperitoneal ureterolithotomy has many advantages over its tranperitoneal counterpart. In the retroperitoneal approach, the tissue planes and anatomy better mimics those of open ureteral surgery, something which most of us are familiar with. A retroperitoneal approach also avoids a breach into the peritoneal cavity. It respects the plane integrity of the retroperitoneal space in which the ureter is residing. However, the working space in the retroperitoneal approach is much smaller than in the transperitoneal approach, this might translate into difficulty in dissection and stitching. A transition from a transperitoneal to a retroperitoneal approach involves many technical issues. Placement of ports, planes identification, position of the assistant surgeon and potential complications are some issues that arise during this transition. In this study, we hope to show that a transition from a transperitoneal to a retroperitoneal approach can be done smoothly and safely.

Role of stents in open ureteral surgery.

Stents can be important adjuncts in open ureteral procedures. The authors provide guidelines to assist the surgeon in deciding whether to employ a stent.