Robotic management of genito-urinary injuries from obstetrical and gynecological operations: A multi-institutional report of outcomes - Abstract

OBJECTIVE: To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynecological (OBGYN) surgery.

METHODS: A retrospective review of all patients from 4 different high volume institutions between 2002 and 2013 that had a robotic assisted repair by an urologist after an OBGYN genitourinary injury.

RESULTS: Of the 43 OBGYN operations, 34 were hysterectomy: 10 open, 10 robotic, 9 vaginally, and 5 pure laparoscopic. Nine patients had alternative OBGYN operations: 3 cesarean sections, 3 oophorectomies (1 open, 2 laparoscopic), 1 robotic colpopexy, 1 open pelvic cervical cerclage with mesh and one robotic removal of an invasive endometrioma. A total of 49 gentiourinary (GU) injuries were sustained: ureteral ligation, n=26, ureterovaginal fistula, n=10, ureterocutaneous fistula, n=1, vesicovaginal fistula (VVF), n=10 and cystotomy alone, n=2. Ten patients (20.4%) underwent immediate urologic repair at the time of their OBGYN robotic surgery. Mean time between OBGYN injury and definitive delayed repair was 23.5 months (1-297). Four patients had undergone prior failed repair: 2 open VVF repair and 2 balloon ureteral dilations with stent placement. A total of 22 ureteral re-implants (11 with ipsilateral psoas hitch) and 15 uretero-ureterostomies were performed. Stents were placed in all ureteral cases for a mean of 32 (1-63) days. Ten VVF repairs and 2 primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for an average of 4.1 days (1-26). No case required open conversion. Two patients (4.1%) developed ureteral obstruction following robotic repair requiring dilation and stenting. Average follow-up of entire cohort was 16.6 months (1-63).

CONCLUSIONS: Robotic repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be utilized successfully immediately following injury recognition or as a salvage procedure after prior attempted repair. Robotic techniques may improve convalescence in a patient population where quick recovery is paramount.

Written by:
Gellhaus PT, Bhandari A, Monn MF, Gardner TA, Kanagarajah P, Reilly CE, Llukani E, Lee Z, Eun DD, Rashid H, Joseph JV, Ghazi AE, Wu G, Boris RS.   Are you the author?
Department of Urology, Indiana University. Indianapolis, IN, USA.

Reference: BJU Int. 2014 Apr 21. Epub ahead of print.
doi: 10.1111/bju.12785

PubMed Abstract
PMID: 24750903 Endourology Section