Robotic Ureteroureterostomy Research Articles

Robot-assisted laparoscopic ureteroureterostomy in a child with upper urinary tract duplication

Upper urinary tract duplication remains one of the most challenging pediatric urology conditions. Various operative methods are used in the treatment of children with this pathology; however, reoperation rate remains high. This study aimed to investigate a case of successful robot-assisted laparoscopic ureteroureterostomy and discuss the technical aspects of this procedure and review known series of robotic ureteroureterostomy. The authors retrospectively reviewed the medical history of a child with duplication of the right kidney, accompanied by reflux of urine into the lower segment collecting system. Surgical intervention was performed using robot-assisted technology. Using computed tomography and voiding cystourethrography, duplex kidney with vesicorenal reflux into the lower segment was diagnosed. The surgical technique used was ureteroureterostomy. The donor ureter was divided in the area of the intended anastomosis. Then, a surgical incision was made in the recipient ureter, the length of which was equal to the diameter of the donor ureter. After preparation of the ureters, an end-to-side anastomosis was performed. The operation was successfully performed without intraoperative difficulties or complications and lasted for 140 minutes. The robot installation time (docking time) was 20 minutes, and the main console time was thus 120 minutes. The patient started feeding on the same day after the operation. The drainage tube was removed after a control ultrasound examination on postoperative day 2. The stent remained in the recipient ureter until its removal 6 weeks after surgery. The duration of follow-up was 6 months. The patient was asymptomatic throughout the control period. Repeated ultrasound examination performed after surgery showed a decrease in the anteroposterior diameter of the lower segment pelvis to 5 mm. Blood flow in the upper and lower segments of the right kidney was not impaired. The advantages of the robotic approach, including improved instrument dexterity and 3D visualization, make it a safe and effective alternative to open or laparoscopic surgery in children.

PE013 - Ureteric tattooing technique for strictures identification in robotic ureteroureterostomy

PE013 - Ureteric tattooing technique for strictures identification in robotic ureteroureterostomy

The First Robotic Day Care Procedure in the Management of Testicular Vein Syndrome: A Rare Cause of Hydroureteronephrosis

Clinical History: A 46-year-old gentleman with no comorbidities presented with dull aching pain in the left loin for 6 months. Physical Examination: Examination was unremarkable. Diagnosis: He was evaluated with contrast-enhanced CT scan of the urinary tract that revealed left gross hydroureteronephrosis secondary to midureteral stricture caused by compression of the left testicular vein. Renogram (diethylenetriamine pentaacetate scan) was performed that showed 44% split renal function of the left kidney with a glomerular filtration rate of 86 mL/min. Intervention: He underwent a day-case robotic ureteroureterostomy and intraoperatively the upper ureter was dilated with testicular vein transposing above the midureter that had a stricture, causing dilatation of proximal ureter with hydronephrosis. Upper ureter was transected above the stricture and brought anterior to the testicular vein and the constricted segment was excised. Ureteroureterostomy was performed over 5F/26 cm Double-J stenting using 2-0 Stratafix suture. Outcomes: Follow-up included stent removal at 6 weeks and serial creatinine thereafter has been normal. Follow-up imaging was done in the form of ultrasonography that showed resolution of hydronephrosis at 3 months and 6 months. Patient Consent Statement: Written informed consent was obtained from the patient to publish this research. No competing financial interests exist.This research received no specific grant from any funding agency, commercial or nonprofit sectors. All authors confirm that they have been involved in the conception and design of the study, drafting of the study for intellectual content, and are accountable to the accuracy of all aspects of the content.Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure Runtime of video: 4 mins 17 secs

V01-09 ROBOTIC URETEROURETEROSTOMY OF RETROCAVAL URETER

You have accessJournal of UrologyCME1 Apr 2023V01-09 ROBOTIC URETEROURETEROSTOMY OF RETROCAVAL URETER Rainjade Chung, Justin Lee, George W Moran, Miyad Movassaghi, Belinda Li, and Christina P. Carpenter Rainjade ChungRainjade Chung More articles by this author , Justin LeeJustin Lee More articles by this author , George W MoranGeorge W Moran More articles by this author , Miyad MovassaghiMiyad Movassaghi More articles by this author , Belinda LiBelinda Li More articles by this author , and Christina P. CarpenterChristina P. Carpenter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retrocaval ureter, also known as “circumcaval ureter” or “preureteral vena cava,” is a relatively rare anatomical variant with an incidence of 0.13% that occurs when the right ureter courses posterior to the vena cava rather than anterior. More commonly seen in males, the etiology is a developmental abnormality of the vena cava, not the ureter. Many cases are clinically silent, but surgical reconstruction is indicated if the patient has severe hydronephrosis, significant functional obstruction, or pain. This patient presented with right flank pain, severe hydronephrosis, and a characteristic "S sign" on retrograde pyelogram (Figure 1). Our objective was to describe our approach to an uncommon case, robotic ureteroureterostomy of a retrocaval ureter. METHODS: The patient was placed in the left lateral decubitus position. The Da Vinci Xi system was utilized and 4 ports were placed in a linear fashion at the lateral border of the rectus 6 cm apart. A 5 mm AirSeal was placed between the 2nd and 3rd arm. ProGrasp Forceps are used in the 1st arm, Maryland bipolar forceps are used in the 2nd arm, and a monopolar curved scissor is used in the 4th arm. Vessel loops were placed on the proximal and distal ureter on either side of the vena cava and were pulled back and forth to allow for visualization and dissection (Figure 2). RESULTS: Successful robotic ureteroureterostomy of a retrocaval ureter. CONCLUSIONS: Robotic ureteroureterostomy is a minimally invasive procedure to manage ureteropelvic junction obstruction caused by a retrocaval ureter. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e82 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rainjade Chung More articles by this author Justin Lee More articles by this author George W Moran More articles by this author Miyad Movassaghi More articles by this author Belinda Li More articles by this author Christina P. Carpenter More articles by this author Expand All Advertisement PDF downloadLoading ...

Safety and feasibility of performing robotic ureteroureterostomy and robotic pyeloplasty in infants

IntroductionOpen surgery is considered the standard of care for pediatric urological procedures. Nonetheless, Robotic Assisted Laparoscopic Surgeries (RALS) have become increasingly popular in pediatrics as they allow for quicker recovery times, lower narcotic use, better cosmesis, and better intraoperative visibility. However, there are concerns regarding the usefulness of RALS in the infant population, as operating on smaller patients limits mobility of the robotic arms and can result in arm collisions.ObjectiveThe aim of this study was to compare the clinical and postoperative outcomes of infants undergoing robotic vs open pyeloplasty or ureteroureterostomy.Materials and MethodsRetrospective study conducted between 2012 to 2022, 114 infants who underwent pyeloplasty (81 open pyeloplasty and 33 robotic pyeloplasty) and 21 who underwent ureteroureterostomy (9 open ureteroureterostomy and 12 robotic ureteroureterostomy) were included.ResultsMean age at surgery in the pyeloplasty cohort was 4.81 ± 3.1 months in the open group, and 6.24 ± 2.6 months in the robotic group (p=0.13), and in the ureteroureterostomy cohort was 7.67 ± 3.16 months in the open group and 7.58 ± 2.75 months in the robotic group (p=0.95). Operative time was found to be shorter in robotic pyeloplasty and robotic ureteroureterostomy, when compared to the open approaches. Postoperative complications, its severity, and the surgical success were comparable among the pyeloplasty and ureteroureterostomy groups. Only 1(3%) complication related to the robotic technique was reported in the pyeloplasty cohort. The length of hospital stay was found to be similar between the ureteroureterostomy groups, while in the pyeloplasty cohort the robotic group showed a significant shorter hospital stay than the open group. Overall, the mean follow-up was greater than 12 months.ConclusionOur results demonstrated that robotic pyeloplasty and ureteroureterostomy performed in infants are feasible, safe, and durable procedures, with an additional benefit of reducing duration of operative time and hospital stay.

Robotic ureteral reimplantation and uretero-ureterostomy treating the ureterovesical junction pathologies in children: technical considerations and preliminary results.

Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) and robotic ureteroureterostomy (RUU) are two mini-invasive surgical techniques that have begun to be performed in pediatric urology in recent years. RALUR has been employed especially for VUR treatment, while RUU is considered principally in case of complex doubled ureteral systems. Our aim is to discuss the safety and feasibility of these approaches in children, focusing on technical considerations and supporting their use in different anomalies and pathologies of the ureterovesical junction. We retrospectively collected data about 58 patients who underwent 44 dismembered RALUR (D-RALUR), 28 non-dismembered RALUR (ND-RALUR) and 5 RUU between May 2020 and December 2021. Indications for surgery were primary or secondary vesicoureteral reflux, megaureter, secondary UVJ obstructions, complicated doubled ureteral systems. Mean age was 3.5years (range 0.6-12.9) and mean weight 17.1 (range 7.2-80). No intraoperative complications occurred nor conversion to open approach were reported. Major postoperative complications were reported in 11.7% of cases with a higher incidence for ND-RALUR. Mean hospital stay was 2.14days (range 1-8). Success rate at the short-term follow-up was 91.9% for D-RALUR, 96.3% for ND-RALUR and 100% for RUU. RALUR and RUU are two feasible and safe procedures to perform in children. RALUR represents the most required and adequate technique in the treatment of UVJ pathologies, however, in selected cases RUU could represent an effective alternative that has to be considered.

A novel tattooing technique for ureteric strictures in robotic ureteroureterostomy: a non-inferiority analysis.

A novel tattooing technique for ureteric strictures in robotic ureteroureterostomy: a non-inferiority analysis.

Intermediate-term outcomes after robotic ureteral reconstruction for long-segment (≥4 centimeters) strictures in the proximal ureter: A multi-institutional experience.

PurposeTo report our intermediate-term, multi-institutional experience after robotic ureteral reconstruction for the management of long-segment proximal ureteral strictures.Materials and MethodsWe retrospectively reviewed our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all patients who underwent robotic ureteral reconstruction for long-segment (≥4 centimeters) proximal ureteral strictures between August 2012 and June 2019. The primary surgeon determined the specific technique to reconstruct the ureter at time of surgery based on the patient's clinical history and intraoperative findings. Our primary outcome was surgical success, which we defined as the absence of ureteral obstruction on radiographic imaging and absence of obstructive flank pain.ResultsOf 20 total patients, 4 (20.0%) underwent robotic ureteroureterostomy (RUU) with downward nephropexy (DN), 2 (10.0%) underwent robotic ureterocalycostomy (RUC) with DN, and 14 (70.0%) underwent robotic ureteroplasty with buccal mucosa graft (RU-BMG). Median stricture length was 4 centimeters (interquartile range [IQR], 4–4; maximum, 5), 6 centimeters (IQR, 5–7; maximum, 8), and 5 centimeters (IQR, 4–5; maximum, 8) for patients undergoing RUU with DN, RUC with DN, and RU-BMG, respectively. At a median follow-up of 24 (IQR, 14–51) months, 17/20 (85.0%) cases were surgically successful. Two of four patients (50.0%) who underwent RUU with DN developed stricture recurrences within 3 months.ConclusionsLong-segment proximal ureteral strictures may be safely and effectively managed with RUC with DN and RU-BMG. Although RUU with DN can be utilized, this technique may be associated with a higher failure rate.

VE44 - Retrograde flexible ureteroscopy-assisted transperitoneal robotic uretero-ureterostomy for refractory ureteral strictures: Technical aspects and early results

VE44 - Retrograde flexible ureteroscopy-assisted transperitoneal robotic uretero-ureterostomy for refractory ureteral strictures: Technical aspects and early results

Tubeless outpatient robotic upper urinary tract reconstruction in the pediatric population: short-term assessment of safety.

Robotic upper urinary tract reconstruction (UUTR) has been widely utilized for surgical management of congenital obstruction. To further reduce morbidity and simplify postoperative care, outpatient robotic pyeloplasty (RP) and robotic ureteroureterostomy (RUU) were performed without ureteral stents, drains, or urethral catheters. The aim of the study was to assess the safety of performing tubeless robotic UUTR as an outpatient procedure. A retrospective review was performed for patients who underwent outpatient tubeless RP and RUU between July 2015 and January 2017. All procedures were primary interventions. No ureteral stents, drains, or urethral catheters were utilized. No regional blocks were utilized. Patients were discharged from the post anesthesia care unit as a scheduled outpatient procedure without an extended stay. Primary outcomes included 30-day complications, emergency room (ER) visits, and readmissions. A total of 19 patients (14 male, 5 female) were identified (RP=17, RUU=3), including one patient who underwent staged bilateral RP. Median age was 21.5months (range 3-220). Median weight was 11.5kg (range 6-89). Median operative time was 167min (range 108-249), defined as skin incision to closure. No 30-day complications, ER visits, or readmissions were observed for any patient. The study concludes that pediatric tubeless outpatient robotic UUTR is safe. Further evaluation is needed to assess this approach on a larger scale, as well as assessing the long-term outcomes of tubeless reconstruction.

Robot-assisted ureteroureterostomy in pediatric patients: current perspectives.

Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.

Innovation in Robotics and Pediatric Urology: Robotic Ureteroureterostomy for Duplex Systems with Ureteral Ectopia.

Robotic technology has been increasingly utilized for complicated reconstructive surgeries in pediatric urology, such as ureteroureterostomy (UU). The literature is limited regarding the performance of minimally invasive UU in children, and the existing published series utilize indwelling ureteral stents. We sought to report on our pediatric experience with robot-assisted laparoscopic (RAL)-UU using a temporary ureteral catheter in duplex systems with ureteral ectopia. A retrospective chart review was performed of all pediatric patients who underwent RAL-UU at a single institution over a 2-year period. An externalized ureteral catheter was kept overnight and removed with the indwelling catheter on postoperative day 1. Intraoperative as well as postoperative complications, length of stay (LOS), and analgesia were recorded. Follow-up renal ultrasound (US) and evaluation for symptom resolution were completed 3 months postoperatively. Twelve patients (four male, eight female) underwent RAL-UU at a mean age of 19.4 months (range 9-48 months) during the study period. The majority of patients (83.3%) presented with hydronephrosis, and all were found to have duplicated systems with ureteral ectopia. No child had ipsilateral vesicoureteral reflux. Two children had bilateral duplicated systems, one of which required bilateral surgery. Median operative time was 138 minutes (IQR 119-180 minutes), and mean estimated blood loss was 1.5 mL. There were no intraoperative complications, and no case required open conversion. Median hospital LOS was 31 hours (IQR 30-39 hours). Median follow-up time was 11 months (range 3-22 months). One patient developed a postoperative febrile upper respiratory infection. All patients had improved hydroureteronephrosis on US at 3 months postoperatively. One patient with preoperative urinary incontinence was dry postoperatively. Therefore, the overall success rate was 100%. Our institutional results demonstrate that RAL-UU utilizing a temporary ureteral catheter is a safe and effective technique for managing duplicated, ectopic ureters in children and infants.

Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions

BackgroundMinimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. ObjectiveTo evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. Design, setting, and participantsThis retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Surgical procedureRobotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Outcome measurements and statistical analysisPreoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitationsNo robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. ConclusionsRobotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. Patient summaryIn this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures.

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

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 ...

Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.

Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.

10 ROBOTIC MANAGEMENT OF BENIGN MID AND DISTAL URETERAL STRICTURE DISEASE: RETROSPECTIVE COMPARISON TO LAPAROSCOPIC APPROACHES AT A SINGLE INSTITUTION

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 201210 ROBOTIC MANAGEMENT OF BENIGN MID AND DISTAL URETERAL STRICTURE DISEASE: RETROSPECTIVE COMPARISON TO LAPAROSCOPIC APPROACHES AT A SINGLE INSTITUTION Kevin Baldie, Jordan Angell, Kenneth Ogan, Nedra Hood, and John Pattaras Kevin BaldieKevin Baldie Atlanta, GA More articles by this author , Jordan AngellJordan Angell Atlanta, GA More articles by this author , Kenneth OganKenneth Ogan Atlanta, GA More articles by this author , Nedra HoodNedra Hood Atlanta, GA More articles by this author , and John PattarasJohn Pattaras Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.052AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral stricture disease has been treated via various surgical approaches. Open repair has traditionally been the gold standard for strictures refractory to endourologic methods. Recent work has shown the efficacy of laparoscopic techniques. We hypothesize that robotic ureteral stricture reconstruction is as effective as laparoscopy. METHODS In an IRB approved retrospective study, 16 patients underwent robotic mid and distal ureteral reconstruction (13 ureteral reimplantations, 3 ureteroureterostomies) at our institution from August 2008 to September 2011. Proximal ureteral stricture, extrinsic obstruction and ureteropelvic junction (UPJ) obstruction cases were excluded. Demographics, perioperative and postoperative data were reviewed and compared to laparoscopic outcomes from our previously published laparoscopic series at the same institution. RESULTS Fourteen of 16 procedures were performed completely robotically in the robotic group. There were two open conversions for Boari flap reconstruction and reimplantation with psoas hitch, respectively. A grade IIIb Clavien complication occurred involving an intraoperative bowel injury requiring additional surgery. By comparison, 5 of 6 procedures in the laparoscopic group were performed completely laparoscopically, with one patient undergoing an elective open conversion to complete the reimplantation. A grade II Clavien complication involving postoperative fevers occurred and was treated via oral antibiotics. Table 1 illustrates outcomes for total robotic, robotic reimplantation (RI), robotic ureteroureterostomy (UU), and laparoscopic reimplantation (RI) groups. All cases were clinically and radiographically successful to date. Data± Total Robotic Robotic RI Robotic UU Laparoscopic RI Demographic n = 16 n = 13 n = 3 n = 6 Age (years) 44(40;23-77) 42(39;23-77) 53(51;51-57) 56(53;35-79) BMI (kg/m2) 28.5(28.1;17.8-42.3) 28.4(27.8;17.8-42.3) 28.8(28.4;20.4-37.7) 27.2(27.1;21.6-32.9) Perioperative Operative Time (minutes) 258.6(252.0;146-450) 266.7(275.0;146-450) 223.0(207.0;168-294) 276.5(277.5;180-360) EBL (mL) 171(100;30-500) 187(100;30-500) 100(100;50-150) 150(175;50-250) LOS (days) 2.5(2;1-8) 2.8(2;1-8) 1.3(1;1-2) 2.7(2;2-5) Complications⁎ IIIb (1) IIIb (1) None II (1) Conversions 2 2 0 1 Postoperative F/U Time (months) 5.4(3.9;1-14) 3.9(2.5;1-12) 11.8(12.3;10-14) 13.2(9.5;2-33) Success C, R: 100 C, R: 100 C, R: 100 C,R: 100 ± Presented as mean (median; range); BMI = body mass index; EBL = estimated blood loss; LOS = length of stay; F/U = follow-up; C = Clinical Success; R = Radiographic Success ⁎ Clavien Classification Grade (events). CONCLUSIONS Though early in our experience, robotic repair of mid and distal ureteral strictures appears to be an efficacious approach for ureteral obstruction. The robotic method may offer additional benefits including improved visualization and technical capacity. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e4 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Baldie Atlanta, GA More articles by this author Jordan Angell Atlanta, GA More articles by this author Kenneth Ogan Atlanta, GA More articles by this author Nedra Hood Atlanta, GA More articles by this author John Pattaras Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V873 ROBOTIC MANAGEMENT OF OBSTRUCTED RETROCAVAL URETER

You have accessJournal of UrologyOncology (TCC & Adrenal) & Teaching Techniques1 Apr 2012V873 ROBOTIC MANAGEMENT OF OBSTRUCTED RETROCAVAL URETER Evalynn Vasquez, Anthony Polcari, David A. Hatch, and Thomas M.T. Turk Evalynn VasquezEvalynn Vasquez Maywood, IL More articles by this author , Anthony PolcariAnthony Polcari Maywood, IL More articles by this author , David A. HatchDavid A. Hatch Maywood, IL More articles by this author , and Thomas M.T. TurkThomas M.T. Turk Maywood, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.967AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retrocaval ureter is a rare congenital anomaly that usually presents in the third or fourth decade with symptoms of obstruction from external compression by the inferior vena cava. Our objective is to demonstrate robotic surgical management of an obstructed retrocaval ureter. METHODS A 40-year-old male with known right retrocaval ureter underwent percutaneous nephrolithotomy for a staghorn calculus in the ipsilateral kidney. Postoperative computed tomography reconfirmed hydroureteronephrosis to the level of L3 where the ureter deviated medially behind the inferior vena cava. The patient returned after several weeks for robot assisted laparoscopic ureteroureterostomy. An open ended ureteral stent was placed cystoscopically before robotic repair was performed. Four ports (two 12 mm and two 8mm) were placed and triangulated to the point of obstruction. Using a transperitoneal approach, the proximal ureter was dissected to the point at which it coursed posterior to the vena cava. From inferiorly, the dissection was carried to a point distal to the site at which the ureter emerged from behind the vena cava. After transecting and spatulating both segments of the ureter, a stented ureteroureterostomy was performed. The retrocaval portion of the ureter was left in place. A drain was brought through the inferior port site. RESULTS The procedures (cystoscopy and robotic ureteroureterostomy) took 262 minutes. Estimated blood loss was 50mL. The patient was discharged home on postoperative day 2 after the drain and Foley were removed. CONCLUSIONS Robotic surgical techniques can be successfully applied to challenging genitourinary conditions such as a retrocaval ureter. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e355 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evalynn Vasquez Maywood, IL More articles by this author Anthony Polcari Maywood, IL More articles by this author David A. Hatch Maywood, IL More articles by this author Thomas M.T. Turk Maywood, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robotic ureteroureterostomy in children with a duplex collecting system.

Duplex collecting system pathology can be handled using an ablative procedure or reconstructive procedure even in the light of a poorly functioning moiety. We propose that, when a reconstructive procedure is an option, a robotic ureteroureterostomy is safe and feasible. Fifteen children between the ages of 6months and 10years (mean 31.26months) underwent transperitoneal robotic ureteroureterostomy for duplex collecting system pathology. The surgical procedure included transperitoneal robotic approach. Outcome measures included operative time, length of hospital stay, and resolution of symptoms. Mean operative time was 1.2h (range 0.75-2.2h) for the entire procedure, including the cystoscopic evaluation. Length of stay averaged 20.8h (range 15-26h). All postoperative imaging demonstrated intact, well-draining collecting systems. The presenting symptomatology resolved in all the patients in whom symptoms were present. Robotic ureteroureterostomy is feasible and safe in the pediatric population and should be considered part of the surgical armamentarium when upper tract preservation seems warranted.