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Khalil N, Sarkis J, Ingels A. Robotic-assisted native pyeloureterostomy with indocyanine green, after kidney transplantation. Asian J Endosc Surg 2024; 17:e13329. [PMID: 38807453 DOI: 10.1111/ases.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Postoperative ureteral strictures and vesicoureteral reflux after ureteroneocystostomy for kidney transplant can be managed by endoscopic procedures like balloon dilation and endoscopic injections. Complicated/recurrent cases, however, are usually managed by reconstructive surgery. We hereby highlight our technique of robotic-assisted native pyeloureterostomy with indocyanine green (ICG). MATERIALS AND SURGICAL TECHNIQUE A 57-year-old woman, diagnosed with grade 4 vesicoureteral reflux on her transplanted kidney, was considered a candidate for ureteral reimplantation. After an endoscopic part, where the ICG is inserted into the renal pelvis, we proceed with the robotic native pyeloureterostomy. The renal pelvis of the transplanted kidney was identified with the help of the ICG in firefly mode. After the dissection of the graft pelvis, we performed a tension-free pyeloureterostomy using the native ureter. The postoperative course was uneventful and the patient was discharged on the third postoperative day. DISCUSSION Robotic-assisted pyelo-ureterostomy appears as a safe and efficient technique for management of complicated urological complications postrenal transplantation using the native ureter. Intrapelvic ICG injection, not possible with open surgery, helps identifying the grafted pelvis thus reducing operative time and avoiding unnecessary dissection of the vascular hilum of the graft. Because of minimal dissection and the short operative time, abdominal drainage is unnecessary and the postoperative course is usually uneventful with a fast discharge from the hospital.
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Affiliation(s)
- Nour Khalil
- Department of Urology, Henri-Mondor University Hospital APHP, Créteil, France
| | - Julien Sarkis
- Department of Urology, Grand Hôpital de l'Est Francilien, Meaux, France
| | - Alexandre Ingels
- Department of Urology, Henri-Mondor University Hospital APHP, Créteil, France
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McCabe M, Sharma A, Kashyap R, Pineda-Solis K, Nair A, Joseph J, Wu G. Robotic-Assisted Management of Ureteral Complications in Post-Renal Transplant Patients: A Case Series and Literature Review. J Laparoendosc Adv Surg Tech A 2024; 34:639-645. [PMID: 38722056 DOI: 10.1089/lap.2024.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open
Abstract
Introduction: Urologic complications are thought to be the most common surgical complication of renal transplantation. Ureteral pathology, including stenosis, urine leak, and vesicoureteral reflux, predominates. Although endourologic and interventional radiological management may be utilized, failure rates remain relatively high and surgical reconstruction remains the definitive management. Robotic ureteral reconstruction has been demonstrated to provide patient benefit in nontransplant populations, but the literature on transplant reconstruction is very limited. This study reports an additional series of patients with a focus on surgical technique, as well as reviews the available evidence for robotic reconstruction for post-transplant ureteral complications. Methods: All institutional patients undergoing robotic-assisted reconstruction for post-transplant ureteral complications for the years 2019-2022 were included. Intra- and postoperative variables, patient demographics, and follow-up data were obtained retrospectively from parsing of patient records. Statistics were tabulated descriptively. Results: Eleven patients underwent ureteral reconstruction. Of the 11, 9 (81%) were male with a mean age of 51.9 years (16-70) and BMI of 33.8 (24.3-49.1). The most common (10/11) indication for reconstruction was stricture; the most common (10/11) technique used was Lich-Gregoir reimplantation. Mean operative time was 288 minutes (143-500). There were no intra- or immediate postoperative complications. Median length of stay was 2 days (1-22). There were two incidences of mortality at 2 and 5 months postoperatively unrelated to surgery. There were four readmissions within 30 days, three for urinary tract infection (UTI) and one for a pelvic abscess which required washout. The remainder of the cohort has been followed for a mean of 14.6 months (6-41) without any incidences of graft loss or recurrence of ureteral pathology. Conclusions: Robotic-assisted ureteral reconstruction is a technically challenging but highly feasible technique that may provide the benefits of minimally invasive surgery while still allowing definitive reconstruction. Centers with extensive robotic capabilities should consider the technique.
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Affiliation(s)
- Michael McCabe
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Ashwani Sharma
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Department of Surgery, Division of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Pineda-Solis
- Department of Surgery, Division of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Amit Nair
- Department of Surgery, Division of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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Chen B, Alford AV, Lonze BE, Zhao LC. Single-port robotic-assisted ureteral reconstruction for management of strictures after renal transplantation. Am J Transplant 2023; 23:1800-1805. [PMID: 37330143 DOI: 10.1016/j.ajt.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/21/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
Ureteral strictures are a common and often challenging complication of renal transplantation. The use of single-port (SP) robotic-assisted laparoscopic surgery is a novel approach in the management of these patients. Here we describe 3 patients with stricture of the transplant ureter causing hydronephrosis and allograft dysfunction, whose ureteral reconstructions were successfully performed using the SP robotic-assisted laparoscopic approach. Two patients underwent transplant-to-native ureteroureterostomy and 1 patient underwent ureteroneocystostomy. We demonstrate that the use of concurrent ureteroscopy and near-infrared fluorescence enables safe and rapid identification of native and transplant ureters. In addition, side-to-side anastomosis of transplant-to-native ureters allows for preservation of ureteral vasculature. In this limited series, the SP robotic platform demonstrates great promise in simplifying and streamlining our approach to ureteral strictures in this patient population.
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Affiliation(s)
- Bofeng Chen
- Department of Urology, NYU Langone Health, New York, New York, USA
| | - Ashley V Alford
- Department of Urology, NYU Langone Health, New York, New York, USA
| | - Bonnie E Lonze
- NYU Langone Transplant Institute, New York, New York, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Health, New York, New York, USA
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Kim J, Yang SJ, Kim DG, Han WK, Na JC. Robotic ureter reconstruction using the native ureter to treat long-segment ureteral stricture of the transplant kidney utilizing Indocyanine green: The first Korean experience. Investig Clin Urol 2023; 64:154-160. [PMID: 36882174 PMCID: PMC9995958 DOI: 10.4111/icu.20220364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Ureteral strictures are a common complication after kidney transplantation. Open reconstruction is preferred for long-segment ureteral strictures that cannot be resolved endoscopically; however, it is known to have the potential to fail. We report 2 successful cases of robotic reconstruction surgery of a transplant ureter using the native ureter with the aid of intraoperative Indocyanine green (ICG). MATERIALS AND METHODS Patients were placed in semi-lateral position. Using Da Vinci Xi, the transplant ureter was dissected, and the stricture site was identified. End-to-side anastomosis of the native ureter to the transplant ureter was performed. ICG was utilized to identify the course of the transplant ureter and confirm the vascularity of the native ureter. RESULTS Case 1: A 55-year-old female underwent renal transplantation at another hospital. She had recurrent febrile urinary tract infections (UTIs) and a ureteral stricture requiring percutaneous nephrostomy (PCN). The PCN and ureteral stent were removed successfully after surgery. The patient had only 1 febrile UTI episode after surgery. Case 2: A 56-year-old female underwent renal transplantation at another hospital. She had acute pyelonephritis 1-month post-transplantation, and a long-segment ureteral stricture was identified. She developed a UTI with anastomosis site leakage in the early postoperative period, which resolved with conservative treatment. The PCN and ureteral stent were removed 6 weeks after surgery. CONCLUSIONS Robotic surgery for managing long-segment ureteral stricture after kidney transplantation is safe and feasible. The use of ICG during surgery to identify the ureter course and its viability can improve the success.
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Affiliation(s)
- Jinu Kim
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Seok Jeong Yang
- Department of Surgery, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Deok Gie Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woong Kyu Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Joon Chae Na
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea.
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Santos Pérez de la Blanca R, Medina-Polo J, Peña-Vallejo H, Juste-Álvarez S, Pamplona-Casamayor M, Duarte-Ojeda JM, Miranda Utrera N, García-González L, Arrébola-Pajares A, Rodríguez Antolín A, Tejido-Sánchez Á. Ureteral Stenosis and Fistula after Kidney Transplantation. Urol Int 2023; 107:157-164. [PMID: 35468605 DOI: 10.1159/000523690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. METHODS Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. RESULTS Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). CONCLUSION Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.
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Affiliation(s)
| | - Jose Medina-Polo
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Helena Peña-Vallejo
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Silvia Juste-Álvarez
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | | | | | | | - Ana Arrébola-Pajares
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Ángel Tejido-Sánchez
- Department of Urology, University Hospital 12 de Octubre (imas12), Madrid, Spain
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The Clinical Study of Bladder Flap Ureteroplasty (Psoas Hitch) in the Treatment of Lower Ureteral Injuries and Strictures (19 Cases). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4607735. [PMID: 35656474 PMCID: PMC9155903 DOI: 10.1155/2022/4607735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to investigate the efficacy and safety of bladder flap ureteroplasty (psoas hitch) in the treatment of lower ureteral injuries and strictures. Methods 19 patients with lower ureteral injuries and strictures scheduled for a bladder flap ureteroplasty (psoas hitch) in our hospital from January 2020 to January 2021 were recruited. The outcome measures included treatment efficacy and safety. Results The operative time, intraoperative bleeding, catheter extubation time, hospital stay, extubation time of ureteral stent, and follow-up time were (125.36 ± 15.38) min, (75.37 ± 11.09) ml, (7.25 ± 1.04) d, (8.76 ± 1.11) d, (46.34 ± 7.66) d, and(19.27 ± 1.27) months, respectively. No serious perioperative adverse reactions were observed, and all the symptoms of patients were relieved. Conclusion Bladder flap ureteroplasty (psoas hitch) is safe and effective for the treatment of lower ureteral injuries, with advantages such as less intraoperative bleeding and trauma and rapid recovery, so it is worthy of promotion. This was a retrospective study supervised by the Ethics Committee of Hebei Yanda Hospital.This trial is registered with no. hebYD076.
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Zhang L, Liu L, Lai X, Fang J, Guo Y, Li G, Xu L, Xiong Y, Yin W, Ma J, Chen Z. Simultaneous antegrade urography of the upper urinary tract and retrograde cystography combined with computed tomography imaging in the management of ureteral complications after renal transplantation. Transl Androl Urol 2021; 10:3620-3627. [PMID: 34733657 PMCID: PMC8511536 DOI: 10.21037/tau-21-614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the significance of simultaneous urography of the upper and lower urinary tract of transplanted kidneys combined with computed tomography urography (CTU), computed tomography arteriography (CTA), and computed tomography venography imaging in the planning of open surgery performed to treat any ureteral complications of a transplanted kidney. Methods In all, 24 patients with ureteral complications after renal transplantation were admitted, 12 of whom had renal graft ostomy during open surgery. Simultaneous antegrade urography of the upper urinary tract and retrograde cystography of the transplanted kidneys were performed on the patients. With the use of computed tomography imaging results, surgical planning was carried out. Results All surgeries were successfully completed according to preoperative planning. Three patients underwent end-to-end anastomosis of the ureter and bladder muscle flap, 8 patients underwent ureterocystostomy, and 1 patient underwent an end-to-end ureteral anastomosis. After the follow-up up to now, all the patients had stable renal function, and no complications such as ureteral stenosis or urine leakage have thus far reoccurred in the transplanted kidneys. Conclusions When open surgery is required to treat any ureteral complications following renal transplantation, preoperative multiangle imaging can be used to better understand the condition of the transplanted urinary tract and thus aid considerably in surgical planning.
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Affiliation(s)
- Lei Zhang
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Organ Transplantation, The Second Clinical Medicine School of Guangzhou Medical University, Guangzhou, China
| | - Luhao Liu
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingqiang Lai
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiali Fang
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuhe Guo
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guanghui Li
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lu Xu
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunyi Xiong
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Yin
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junjie Ma
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zheng Chen
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Organ Transplantation, The Second Clinical Medicine School of Guangzhou Medical University, Guangzhou, China
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Malinzak L, McEvoy T, Denny J, Kim D, Stracke J, Jeong W, Yoshida A. Robot-assisted Transplant Ureteral Repair to Treat Transplant Ureteral Strictures in Patients after Robot-assisted Kidney Transplant: A Case Series. Urology 2021; 156:141-146. [PMID: 34058240 DOI: 10.1016/j.urology.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the use of robotic-assisted transplant ureteral repair (RATUR) for treating transplant ureteral stricture (TUS) in 3 patients who had undergone robot assisted kidney transplant (RAKT). METHOD We reviewed the medical records of 3 patients who experienced TUS after RAKT and who underwent RATUR between 2017 and 2020. The patients' RAKT, post-transplant clinical course, endourological interventions, reoperation, and recovery were assessed. RESULTS All patients diagnosed with TUS presented with deterioration of kidney function after RAKT. Method of diagnosis included ultrasound, antegrade ureterogram, and CT scan. All 3 patients had a short (<1 cm) area of TUS and underwent RATUR. For 2 patients, distal strictures were bypassed with modified Lich-Gregoir ureteroneocystostomy reimplantation. One patient was treated with pyelo-ureterostomy to the contralateral native ureter. No intraoperative complications, conversions to open surgery, or significant operative blood loss requiring blood transfusion for any patient were observed. Also, no patients had urine leaks in the immediate or late postoperative period. After RATUR, 2 patients developed Clavien grade II complications with rectus hematoma or urinary tract infection. CONCLUSION RATUR is a technically feasible operation for kidney transplant patients with TUS after RAKT. This procedure may provide the same benefits of open operation without promoting certain comorbidities that may occur from open surgical procedures.
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Affiliation(s)
- Lauren Malinzak
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202.
| | - Tracci McEvoy
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Jason Denny
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Dean Kim
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Joel Stracke
- Mercy Health St. Mary's Hospital, Grand Rapids, MI 49503
| | - Wooju Jeong
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
| | - Atsushi Yoshida
- Transplant Henry Ford Medical Group, Henry Ford Hospital, Detroit, MI 48202
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Corbett J, Noh PH. Pediatric Robotic Transplant Ureteral Reimplantation for Vesicoureteral Reflux. J Endourol Case Rep 2020; 6:96-98. [PMID: 32775689 DOI: 10.1089/cren.2019.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The first published report of a pediatric robotic extravesical transplant ureteral reimplantation for vesicoureteral reflux (VUR) in a renal allograft is described. Case Presentation: The patient is an 11-year-old Caucasian girl who had acute allograft pyelonephritis and was subsequently found to have dilating VUR. Conclusion: Robotic surgery facilitated an effective nondismembered extravesical reimplant with minimal morbidity.
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Affiliation(s)
- Jonathan Corbett
- Division of Urology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Paul H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Li B, Liu DB, Gong EM. Robot-assisted laparoscopic transplant-to-native ureteroureterostomy of an intraperitoneal renal allograft. J Pediatr Urol 2018; 14:356-357. [PMID: 30017605 DOI: 10.1016/j.jpurol.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective is to describe our experience with robot-assisted laparoscopic transplant-to-native ureteroureterostomy (UU) in a pediatric patient with an intraperitoneal renal allograft. We have previously demonstrated this technique for an extraperitoneal allograft. METHODS The patient is a 17-year-old female who had undergone a deceased donor renal transplant at 5 years of age. She developed acute kidney injury and hydronephrosis because of a ureteral stricture that developed after a right ovarian cyst excision. A retrograde pyelogram of her native ureter showed normal morphology. Her options were discussed and she proceeded with a robotic transplant-to-native UU. RESULTS Robot-assisted laparoscopic transplant-to-native UU was performed via an intraperitoneal approach. The procedure time was 217 min with an estimated blood loss of 10 mL. Her postoperative course was unremarkable. After ureteral stent removal, her serum creatinine remained stable and follow-up imaging showed an improvement in hydronephrosis. CONCLUSIONS Pediatric robot-assisted laparoscopic transplant-to-native UU for an intraperitoneal allograft is a technically feasible approach for the treatment of transplant ureteral strictures that combines the durability of open revision with the minimal invasiveness of endourologic management.
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Affiliation(s)
- Belinda Li
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Kroczak T, Reynolds LF, Ordon M. Robotic Autotransplantation and Management of Post-transplant Anastomotic Strictures: the Future Is Here. Curr Urol Rep 2018; 19:31. [PMID: 29572617 DOI: 10.1007/s11934-018-0781-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW We set out to review the current published experience with robotic autotransplantation. Although the experience to date is limited, this surgery appears to be safe and technically feasible. We also examined the use of the robotic surgical platform for the management of post-transplant uretero-vesical anastomotic strictures. RECENT FINDINGS To date, only four reported cases of robotic autotransplantation have been described with two being performed completely intra-corporeally. An intra-corporeal approach is feasible for benign conditions, while malignant masses should be inspected and dissected extra-corporeally. Ureteric strictures after renal transplantation are common. To date, the experience with robotic surgical management is limited but has also been shown to be safe and feasible. While robotic autotransplantation is still in its infancy, it is feasible and appears to be safe. Renal allograft function and surgical outcomes are favorable and provide patients the option to have a historically more morbid surgery performed with a minimally invasive approach.
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Affiliation(s)
- Tad Kroczak
- St. Michael's Hospital, Division of Urology, Department of Surgery, University of Toronto, 61 Queen St East Suite 9-103, Toronto, ON, M5C 2T2, Canada
| | - Luke F Reynolds
- St. Michael's Hospital, Division of Urology, Department of Surgery, University of Toronto, 61 Queen St East Suite 9-103, Toronto, ON, M5C 2T2, Canada
| | - Michael Ordon
- St. Michael's Hospital, Division of Urology, Department of Surgery, University of Toronto, 61 Queen St East Suite 9-103, Toronto, ON, M5C 2T2, Canada.
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