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KMID : 0358320130540080516
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Korean Journal of Urology
2013 Volume.54 No. 8 p.516 ~ p.521
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Single-Surgeon Experience With Robot-Assisted Ureteroneocystostomy for Distal Ureteral Pathologies in Adults
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Lee Ziho
Sehgal Shailen
Llukani Elton
Reilly Christopher
Doumanian Leo
Mydlo Jack
Lee David Inkoo
Eun Daniel Dong-In
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Abstract
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Purpose: To demonstrate our technical approach for robot-assisted ureteroneocystostomy (R-UNC) for benign and malignant distal ureteral pathologies. Materials and Methods: Between January 2009 and January 2013, a total of 10 patients underwent R-UNC in the distal ureter by a single surgeon. Indications for R-UNC were as follows: idiopathic (3), fistula (2), iatrogenic (2), malignancy (2), and chronic vesicoureteral reflux (1). Results: Tension-free anastomosis was attained in all 10 R-UNC procedures. A psoas hitch was performed in 6/10 cases (60%). Intravesical and extravesical reimplantations were completed in 5/10 (50%) and 5/10 cases (50%), respectively. A nonrefluxing ureter was constructed in 2/10 cases (20%). The patients’ mean age was 52.9±16.6 years, their mean body mass index was 30.8±6.3 kg/m2, the mean operative time was 211.7±69.3 minutes, mean estimated blood loss was 102.5±110.8 mL, and mean length of stay was 2.8±2.3 days. There were no intraoperative complications. There was one Clavien-Dindo grade I and one Clavien-Dindo grade II postoperative complication. The mean postoperative follow-up duration was 28.5±15.5 months. Two patients had recurrence of ureteral strictures at 3 months postoperatively and were managed successfully with balloon dilation. Conclusions: Our technique for R-UNC demonstrates good perioperative outcomes. However, underlying periureteral inflammation and pelvic adhesions may predispose patients for stricture recurrence after R-UNC.
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KEYWORD
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Minimally invasive surgical procedures, Reconstructive surgical procedures, Ureter
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