To describe the step-by-step techniques for robotic ureteral reimplantation performed by using the Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA). Different case-scenarios were included with an educational purpose.
Three consecutive patients diagnosed with distal benign ureteral strictures were counseled for ureteral reimplantation and accepted to undergo surgery performed by using the da Vinci SP® surgical system. Demographics and perioperative outcomes were collected under institutional review board approval (IRB 13-780). Subjects were provided with informed consent explaining the adoption of the novel platform. The first patient was a woman referred to our Institution for a left distal ureteral stricture status post total hysterectomy for uterine fibroids with ureteral injury. The second patient was a man with benign prostate hyperplasia and recurrent urinary tract infections, who was diagnosed with a 1.5 cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero-enteric anastomoses strictures status post radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer.
The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed in the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port's wound was used to accommodate the drainage. On the other hand, the bilateral ureteral reimplantation was completed according to a pure single-site approach (no extra-ports were placed out of the GelSeal cap). Mean operative time was 165, 150 and 180 minutes, respectively. Blood losses were 50 ml. No intraoperative complications occurred. Patients were discharged on postoperative day one, one and two, respectively, with normal serum creatinine. Neither transfusions nor major complications occurred.
Robot-assisted reconstructive surgery for benign distal ureteral strictures is feasible and safe using the da Vinci SP® surgical system. This article is protected by copyright. All rights reserved.
BJU international. 2018 Nov 30 [Epub ahead of print]
Jihad Kaouk, Juan Garisto, Mohamed Eltemamy, Riccardo Bertolo
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.