Transnephrostomic ICG guided robotic ureteral reimplantation for ureteroileal strictures after robotic cystectomy and neobladder

You have accessJournal of UrologyReconstruction - Upper Urinary Tract1 Apr 2018V04-03 TRANSNEPHROSTOMIC ICG GUIDED ROBOTIC URERETAL REIMPLANTATION FOR URETEROILEAL STRICTURES AFTER ROBOTIC CYSTECTOMY AND NEOBLADDER: STEP BY STEP TECHNIQUE Giuseppe Simone, Gabriele Tuderti, Leonardo Misuraca, Mariaconsiglia Ferriero, Giulio Vallati, Francesco Minisola, Salvatore Guaglianone, and Michele Gallucci Giuseppe SimoneGiuseppe Simone More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Giulio VallatiGiulio Vallati More articles by this author , Francesco MinisolaFrancesco Minisola More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , and Michele GallucciMichele Gallucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video we describe our initial experience with robotic ureteral reimplantation for uretero-enteric anastomotic strictures in patients previously treated with robot assisted radical cystectomy and intracorporeal neobladders (RARC-N) with the use of near infrared fluorescence (NIRF) imaging after transnephrostomic injection of indocyanine green (ICG). METHODS From April 2015 to October 2017, 9 consecutive patients underwent robotic ureteral reimplantation in one tertiary referral center. All patients previously underwent RARC-N with the same standardized technique [1]. All patients previously underwent percutaneous nephrostomy and at least one antegrade stenting and stricture dilatation attempt. This was a case of a 64 year old male, with a 2.5 centimeters left ureteral stricture, who underwent RARC-N 10 months ago.As shown in the video, transnephrostomic injection of ICG was performed to identify the lumbar ureter. The ureter was then progressively dissected and encircled with a vessel loop. A gentle traction was applied on the vessel loop and blunt and shurp dissection were alternatively used to develop the dissection plane, with a totally no touch technique.Intravenous ICG was injected and allowed to easily identify the left iliac artery.After iliac vessel identification, the stenotic tract of the ureter was identified and the neobladder opened. The left ureter was transected 1 cm proximally to the stenotic tract, spatulated and approximated to the neobladder flap. Uretero-ileal anastomosis was performed with interrupted 3-0 Monocryl sutures and neobladder Boari flap was closed. RESULTS Median time from RARC to uretero-anastomotic stricture diagnosis was 5mo (IQR2-6). Median stricture length was 1,5 cm (IQR 1-2). Median operative time was 140 minutes (IQR 81-155) and median length of stay was 5 days (IQR 3-9).All cases were completed robotically. Neobladder Boari flap was created in all cases.Two patients experienced a Clavien grade 2 complication (one urinary tract infection requiring antibiotics and one blood transfusion, respectively). One patient underwent ileum resection and anastomosis due to perforation. At a median follow-up of 7 mo (IQR 4-25) no patients developed recurrence (CT scan) or worsening of renal function (new onset CKD stage 3b-4). CONCLUSIONS Robotic eureteral reimplantation for uretero-enteric strictures is a safe and highly effective procedure. Near infrared fluorescence imaging provides an easy guide to identify and progressively dissect the ureter. Thanks to the high success rate and to the excellent functional outcomes, robotic reimplantation has become a first treatment option in our center. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e407 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Giuseppe Simone More articles by this author Gabriele Tuderti More articles by this author Leonardo Misuraca More articles by this author Mariaconsiglia Ferriero More articles by this author Giulio Vallati More articles by this author Francesco Minisola More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...