V504 ROBOTIC URETERAL RECONSTRUCTION: TECHNIQUE AND OUTCOMES

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V504 ROBOTIC URETERAL RECONSTRUCTION: TECHNIQUE AND OUTCOMES Rakesh Khanna, Fatih Altunrende, Wahib Isac, Riccardo Autorino, Michael A. White, Bo Yang, Humberto K. Laydner, Gregory Spanna, Shahab Hillyer, Gaurang Shah, Georges-Pascal Haber, Jihad H. Kaouk, and Robert J. Stein Rakesh KhannaRakesh Khanna Cleveland, OH More articles by this author , Fatih AltunrendeFatih Altunrende Cleveland, OH More articles by this author , Wahib IsacWahib Isac Cleveland, OH More articles by this author , Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Michael A. WhiteMichael A. White Cleveland, OH More articles by this author , Bo YangBo Yang Cleveland, OH More articles by this author , Humberto K. LaydnerHumberto K. Laydner Cleveland, OH More articles by this author , Gregory SpannaGregory Spanna Cleveland, OH More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Gaurang ShahGaurang Shah Cleveland, OH More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , Jihad H. KaoukJihad H. Kaouk Cleveland, OH More articles by this author , and Robert J. SteinRobert J. Stein Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.600AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral reconstruction may be required in the setting of iatrogenic injury to the ureter, infectious strictures, endometriosis, trauma or malignancy. Laparoscopic techniques can be extremely challenging due to the difficult dissection and advanced reconstruction. We describe our technique of robotic ureteroneocystostomy including psoas hitch and Boari flap and report outcomes at our institution. METHODS The technique is performed as follows: 1) The patient is placed in the lithotomy position and tilted away from the side of pathology. A 3 or 4-port robotic approach is used. 2) Ureteral isolation is performed with differences on the right and left side depicted. 3) Great care is taken to correlate preoperative stricture location to the site of intraoperative ureteral transection. Spatulation is carried proximally until the ureter is widely patent. 4) The bladder is mobilized. 5) If the ureter is able to reach the bladder under little tension, a primary ureteroneocystostomy is performed. 6) If necessary a psoas hitch can be performed using at least two interrupted sutures anchoring the bladder dome to the to the psoas muscle. 7) For more proximal strictures a Boari flap is performed. A flap is outlined with a length to base ratio of 3:1. 8) Reconstruction is performed as depicted. 9) An internal stent is left indwelling. RESULTS A chart review of all patients undergoing robotic surgery from 2007–2010 yielded a total of 25 robotic reconstructive urologic procedures being performed. These include 10 primary ureteroneocystostomies, 11 Boari Flap procedures, and 4 Psoas hitch procedures. The mean operative time was 273 minutes, mean estimated blood loss was 128 cc and mean length of stay was 4 days. Complications included 2 urinary tract infections. Mean operative time for patients requiring a Boari flap was 312 minutes, mean estimated blood loss 122 cc and hospital stay was 4.2 days. No complications occurred in this cohort of patients. CONCLUSIONS Robotic ureteral reimplantation appears effective and can be applied for various indications. Advantages include precise dissection with 3-dimensional visualization and wristed instrumentation which can prove helpful for advanced sutured reconstruction. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e204 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rakesh Khanna Cleveland, OH More articles by this author Fatih Altunrende Cleveland, OH More articles by this author Wahib Isac Cleveland, OH More articles by this author Riccardo Autorino Cleveland, OH More articles by this author Michael A. White Cleveland, OH More articles by this author Bo Yang Cleveland, OH More articles by this author Humberto K. Laydner Cleveland, OH More articles by this author Gregory Spanna Cleveland, OH More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Gaurang Shah Cleveland, OH More articles by this author Georges-Pascal Haber Cleveland, OH More articles by this author Jihad H. Kaouk Cleveland, OH More articles by this author Robert J. Stein Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...