WCE 2017: The Outcome of Robotic Boari Flap

Vancouver, Canada (UroToday.com) Dr. Salkini, associate professor of surgery from West Virginia University presented his experience of using the Boari Flap with the robot. Ureteroneocystostomy with the creation of a Boari flap represents a good option to substitute for the loss of the distal ureter in both benign and malignant conditions. Traditionally the procedure was performed through a large midline or Gibson incision. However, with the advent of robotic surgery, particularly the da Vinci surgical system, this procedure can now be done through a minimally invasive approach.

In his practice from 2009 – 2017, Dr. Salkini has utilized the da Vinci system to reconstruct 13 distal ureters for 4 benign and 9 malignant conditions. In 10 of these cases his team used 5 W shaped trocars, and added a 6th trocar for assistance in the other three. During the surgery, Dr. Salkini explains that they spatulate the reaming ureteral end and re-implant it end to end to the Boari Flap. He emphasizes that in all their cases they obtained negative margins. All cases were completed robotically and the patients were followed up on average for 35 months.

His team found that all of the ureters were patent in patients who were treated for benign disease. However, three patients treated for a malignant condition developed a stricture at the ureterovesical anastamosis. On initial and final pathology, all the strictures were due to high grade transitional cell carcinoma after the nephroureterectomy. One patient developed multifocal high grade transitional cell carcinoma (TCC) in the renal pelvis on the same side in 3 years.

Dr. Salkini concludes that robotic reconstruction of the lower ureter with Boari flap is feasible and has an acceptable oncologic outcome. He points out that high grade TCC of the lower ureter is a predictor of recurrence at the anastomosis and that longer follow up is needed especially in cases of malignancy.

Presented by: Mohamad W. Salkini, MD, FACS 

Authors: Mohamad W. Salkini, MD, FACS Nabhan Idris, MD
Affiliation: West Virginia University, Vaxjo, Varmlands Lan, Sweden

Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.