Background and Purpose: Use of the robotic platform for urinary reconstructive surgery is growing in popularity since its initial application with pyeloplasty for UPJ repair.
Although clinical series of adult robotic ureteral reconstruction do appear in the literature, these reports tend to be limited in size and scope. We present the largest series to date of patients undergoing surgery for any obstruction distal to the UPJ with outcomes and short-term follow-up.
Patients and Methods: A retrospective chart review was performed for patients undergoing robotic ureteral reconstructive procedures for any indication at our institution. Patients undergoing pyeloplasty, planned open procedures, and pediatric patients were excluded from the current analysis. Patient demographic data, etiology, procedure performed, and perioperative outcomes were reviewed. Postoperative follow-up, imaging, and any re-interventions were also captured. The procedures performed included ureteroneocystostomy, psoas hitch, Boari flap, ureteroureterostomy, ureterolysis, ureterolithotomy, and nephropexy.
Results: A total of 55 patients underwent robotic ureteral reconstructive procedures distal to the UPJ. Of these patients, 45 underwent intervention for a benign etiology and 10 for upper tract malignancy. All cases were successfully completed robotically with no open conversions and no intraoperative complications. Concurrent endoscopy was performed in 31 patients. The median OR time was 221 minutes overall. Median blood loss was 50 ml with no intraoperative transfusions. The average hospital stay was 1.6 days, with 39 patients (71%) discharged on post-operative day 1. All surgical margins were negative for malignancy. The median follow-up with imaging was 181 days. There were 2 serious complications (3.6%) and 3 failures (5.3%).
Conclusions: Robotic reconstruction of the ureter distal to the UPJ is feasible, safe, effective, and able to replicate techniques of open surgery with equivalent outcomes to large robotic pyeloplasty and smaller distal ureteral reconstruction series.
Fifer GL, Raynor MC, Selph P, Woods ME, Wallen EM, Viprakasit DP, Nielsen M, Smith AM, Pruthi RS. Are you the author?
University of North Carolina, Department of Urology, 2113 Physicians Office Building, Campus Box 7235, Chapel Hill, North Carolina, United States.
Reference: J Endourol. 2014 Aug 5. Epub ahead of print.