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Yang W, Tang W, Zheng X, Zhang M, Lu X, Chen Z, Ji C, Guo H. Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures. BMC Urol 2023; 23:161. [PMID: 37828507 PMCID: PMC10571485 DOI: 10.1186/s12894-023-01333-3] [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] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To summarize the efficacy of combined robot-assisted laparoscopy and ureteroscopy in treating complex ureteral strictures. METHODS Eleven patients underwent combined robot-assisted laparoscopy and ureteroscopy for ureteral strictures between January 2020 and August 2022. Preoperative B-ultrasound, glomerular filtration rate measurement, and intravenous pyelography showed different degrees of hydronephrosis in the affected kidney and moderate to severe stenosis in the corresponding part of the ureter. During the operation, stricture segment resection and end-to-end anastomosis were performed using the da Vinci robot to find the stricture point under the guidance of a ureteroscopic light source in the lateral or supine lithotomy position. RESULTS All the patients underwent robot-assisted laparoscopy and ureteroscopy combined with end-to-end ureterostenosis. There were no conversions to open surgery or intraoperative complications. Significant ureteral stricture segments were found in all patients intraoperatively; however, stricture length was not significantly different from the imaging findings. Patients were followed up for 3-27 months. Two months postoperatively, the double-J stent was removed, a ureteroscopy was performed, the ureteral mucosa at the end-to-end anastomosis grew well, and the lumen was patent in all patients. Furthermore, imaging examination showed that hydronephrosis was significantly improved in all patients, with grade I hydronephrosis in three cases and grade 0 hydronephrosis in eight cases. No recurrence of ureteral stricture was observed in patients followed up for > 1 year. CONCLUSION Robot-assisted laparoscopy combined with ureteroscopy is an effective method for treating complex ureteral strictures and can achieve accurate localization of the structured segment.
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Affiliation(s)
- Wenjin Yang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Weinan Tang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xi Zheng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Mengjie Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xinyi Lu
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Zeqing Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
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Corse TD, Dayan L, Cheng N, Brown A, Krishnan N, Mishra K, Sanchez De La Rosa R, Ahmed M, Lovallo G, Eun DD, Zhao LC, Stifelman MD. A Multi-Institutional Experience Utilizing Boari Flap in Robotic Urinary Reconstruction. J Endourol 2023; 37:775-780. [PMID: 37128188 DOI: 10.1089/end.2022.0618] [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: 05/03/2023] Open
Abstract
Objectives: There is presently scarce literature describing the outcomes of patients undergoing robotic ureteral reconstruction (RUR) using the Boari flap (BF) technique. Herein, we report our prospective, multi-institutional experience using BF in patients undergoing robotic urinary reconstruction. Patients and Methods: We reviewed our prospective, multicenter database for all patients undergoing RUR between September 2013 and September 2021 in which a BF was utilized. Preoperative, perioperative, and follow-up data were collected and analyzed. Major complications were defined as a Clavien-Dindo classification grade >2. Surgical failure was defined as recurrent symptoms, obstruction on imaging, or the need for additional surgical interventions. Results: We identified 50 patients who underwent RUR using a BF. Four (8%) underwent the Single Port approach. Twenty-four patients (48%) were active or former tobacco users. Thirty-four patients (68%) had previously undergone abdominal surgery, 17 (34%) had prior ureteral stricture interventions, and 9 (18%) had prior abdominopelvic radiation. The most common stricture etiology was malignancy (34.4%). The median follow-up was 15.0 months with a 90% (45/50) success rate. The five documented cases of failure occurred at a median of 1.8 months following the procedure. Conclusion: In the largest prospective, multi-institutional study of patients undergoing RUR with BF in the literature to date, we demonstrate a low rate of complications and a high rate of surgical success in three tertiary academic medical centers. All observed failures occurred within 2 months of surgical intervention.
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Affiliation(s)
- Tanner D Corse
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Linda Dayan
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Nathan Cheng
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Allison Brown
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Naveen Krishnan
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kirtishri Mishra
- Department of Urology, New York University, Langone Medical Center, New York, New York, USA
| | | | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Gregory Lovallo
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lee C Zhao
- Department of Urology, New York University, Langone Medical Center, New York, New York, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
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Ramesmayer C, Pallauf M, Gruber R, Kunit T, Oswald D, Lusuardi L, Mitterberger M. Uretero-neocystostomy: a retrospective comparison of open, laparoscopic and robotic techniques. BMC Urol 2023; 23:35. [PMID: 36882812 PMCID: PMC9993581 DOI: 10.1186/s12894-023-01200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Uretero-neocystostomy (UNC) is the gold-standard for distal-ureter repair. Whether the surgery should be conducted minimally invasive (laparoscopic (LAP), robotic RAL)) or open remains unanswered by the literature. METHODS Retrospective analysis of surgical outcome of patients treated with UNC for distal ureteral stenosis (January 2012 - October 2021). Patient demographics, estimated blood loss (EBL), surgical technique, operative time, complications and length of hospital stay (LOS) were recorded. During the follow-up period, patient underwent renal ultrasound and kidney function tests. Success was defined as relieve of symptoms or no findings of obstruction needing urine drainage. RESULTS 60 patients were included (9 RAL, 25 LAP, 26 open). The different cohorts were similar of age, gender, American Society of Anesthesiologists (ASA) score, body-mass index and history of prior treatment of the ureter. No intraoperative complications were detected in all groups. There was no conversion to open surgery in the RAL group, whereas one was found in the LAP arm. Six patients had a recurrent stricture, but with no significant difference between the cohorts. EBL was not different between the groups. LOS was significantly lower in the RAL + LAP group compared to open (7 vs. 13 days, p = 0.005) despite significantly longer operating times (186 vs. 125.5 min, p = 0.005). CONCLUSION Minimal invasive UNC, especially RAL, is a feasible and safe surgical method and provides similar results in terms of success rates in comparison to open approach. A shorter LOS could be detected. Further prospective studies need to be done.
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Affiliation(s)
- Christian Ramesmayer
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Maximilian Pallauf
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Ricarda Gruber
- Department of Urology and Andrology, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Thomas Kunit
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - David Oswald
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Mitterberger
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Application of Indocyanine Green in Combination with Da Vinci Xi Robot in Surgeries on the Upper Urinary Tract: A Case Series Study. J Clin Med 2023; 12:jcm12051980. [PMID: 36902765 PMCID: PMC10004405 DOI: 10.3390/jcm12051980] [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: 12/23/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND To explore the application value of intraoperative imaging by indocyanine green (ICG) injection through the collection system of the urinary tract for Da Vinci Xi robot navigation in complex surgeries on the upper urinary tract. METHODS Data of 14 patients who underwent complex surgeries of the upper urinary tract post-ICG injection through the collection system of the urinary tract in combination with Da Vinci Xi robot navigation in the Tianjin First Central Hospital between December 2019 and October 2021 were analyzed in this retrospective study. The operation duration, estimated blood loss, and exposure time of ureteral stricture to ICG were evaluated. The renal functions and tumor relapse were evaluated after surgery. RESULTS Of the fourteen patients, three had distal ureteral stricture, five had ureteropelvic junction obstruction, four presented duplicate kidney and ureter, one had a giant ureter, and one presented an ipsilateral native ureteral tumor after renal transplantation. The surgeries in all patients were successful, with no conversion to open surgery. In addition, no injury to the surrounding organs, anastomotic stenosis or leakage, or ICG injection-related side effects were detected. Imaging at 3 months post-operatively revealed improved renal functions compared to those before the operation. No tumor recurrence or metastasis was observed in patient 14. CONCLUSION Fluorescence imaging compensating for the inadequacy of tactile feedback in the surgical operating system has advantages in identifying the ureter, determining the site of ureteral stricture, and protecting the blood flow for the ureter.
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ROBOT Assisted Laparoscopic Surgeries For Nononcological Urologic Disease: Initial Experience With Hugo Ras System. Urology 2023; 174:118-125. [PMID: 36804552 DOI: 10.1016/j.urology.2023.01.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To report our initial experience with the use of HUGO Robotic Assisted Surgery System (RAS) for nononcological urologic disease. METHODS We collected retrospective data describing clinical outcomes from patients undergoing surgeries for nononcological urologic disease with the new HUGO RAS. Analysis included: total surgery and console time, docking time, estimated bleeding, complications, and pain after surgery. RESULTS There were 5 patients operated for nononcological urologic disease. The mean age was 50 years (range 32-70), comorbidities were mild (2 patients with chronic hypertension) and American Society of Anesthesiologists (ASA) classification was 2. Total surgical time ranged from 150 to 257 minutes, and console time from 89 to 164 minutes, each depending on the intervention. The mean docking time was 8.5 minutes (range 5.7-11). No intraoperative complications, instrument clashes, or system failure that compromised the surgery's completion were recorded. Mean blood loss ranged from 10-30 mL, and there were no postoperative complications. Postoperative pain classified from 0-10 at 1, 6, and 12 hours was low (range 0-3), and pain before discharge was 0 for all patients. Hospital stay ranged from 2 to 5 days, depending on the intervention. CONCLUSION Robotic surgery was introduced in early 2000s and was rapidly adopted. Initially, this technology was reserved for oncological surgery, later expanding to nononcological conditions. These preliminary results are comparable to the previous robotic systems, suggesting the multiple potential uses of the HUGO RAS. The adoption of this technology has the potential to improve patient accessibility for less-invasive therapies in developing countries.
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Robot-Assisted versus Trans-Umbilical Multiport Laparoscopic Ureteral Reimplantation for Pediatric Benign Distal Ureteral Stricture: Mid-Term Results at a Single Center. J Clin Med 2022; 11:jcm11216229. [PMID: 36362458 PMCID: PMC9656945 DOI: 10.3390/jcm11216229] [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: 08/09/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Objective: Robot-assisted laparoscopic ureteral reimplantation (RALUR) and trans-umbilical multiport laparoscopic ureteral reimplantation (TMLUR) are both minimally invasive procedures for benign distal ureteral stricture (DUS). However, TMLUR has rarely been reported in published research, thus the difference in mid-term outcome of these two procedures warrants investigation. Methods: Patients who underwent RALUR or TMLUR for pediatric DUS from April 2017 to November 2020 at our institution were retrospectively analyzed and 56 patients were included in this retrospective comparison. Demographic characteristics, perioperative data and follow-up results were collected and analyzed in RALUR and TALUR groups. Results: RALUR and TMLUR were successfully performed in children aged from 12.0 to 142.0 months, without conversion to open ureteral reimplantation. RALUR took shorter operative time than TMLUR (p = 0.005) with less blood loss (p = 0.001). Meanwhile, patients receiving RALUR encountered a greater financial burden (p < 0.001) with less cosmetic satisfaction than TMLUR. The mean mid-term follow-up time for RALUR and TMLUR was 18.29 months and 24.64 months, respectively. Mid-term follow-up data showed that DUS was relieved with improved renal function after surgery in both groups, with no significant difference. Conclusions: RALUR and TMLUR are both safe and efficient for DUS treatment and achieve comparable mid-term outcomes in children. RALUR can reduce operative time and operative blood loss benefiting from its prominent technical superiority, but may currently bring about greater financial burden, with cosmetic satisfaction remaining to be improved.
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Zhang G, Zhao J, Zhao G, Niu Z, Liu P, Sun L. Laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures: our experience. Int Urol Nephrol 2022; 54:1865-1870. [PMID: 35594006 DOI: 10.1007/s11255-022-03224-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was designed to evaluate the feasibility of laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures of the middle and lower ureters. By observing its curative effect and prognosis, we can provide a safer and reliable treatment option for patients with middle and lower ureteral injury. METHODS In this study, of the eight cases under study, five were diagnosed with long-segment ureteric strictures, one had long-segment ureteric avulsion, one was diagnosed with ureteral rupture caused by surgical injury of appendicitis, and the remaining one underwent ureterostomy after ureteral injury. The location of ureteral injury was in the middle lower segment. All eight patients underwent laparoscopic ureteral reimplantation with a Boari flap from January 2018 to October 2021. In this study, two patients were treated with a Boari bladder flap with psoas hitching. All procedures were performed by the same surgeon with over 20 years of experience in urological surgery. RESULTS The mean length of ureteric avulsion or ureteric strictures was 7.94 cm (range, 4-15 cm). Laparoscopic ureteral reimplantation with a Boari flap was performed successfully between 120 and 240 min. The mean duration of postoperative hospital stay was 6 days, and no major complications related to the procedure in the perioperative period occurred. Postoperative follow-up showed no obvious hydronephrosis on computed tomography urography or urinary ultrasound in all eight patients. Postoperative reexamination did not reveal any significant hydronephrosis, urinary tract infection, or ureteral reflux, and none of the postoperative renal functions were abnormal. CONCLUSIONS Laparoscopic ureteral reimplantation with a Boari flap is safe and feasible for experienced physicians. In our case, the length/width ratio of bladder flap is more than 4:1, with good blood supply and no obvious complications, it provides a longer alternative length.
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Affiliation(s)
- Guanglei Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Jiming Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Guiting Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Ping Liu
- Institute of Orthopaedic Basic and Clinical Transformation, University of Shanghai for Science and Technology, Shanghai, China.,The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Liang Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Bausch K, Sauter R, Subotic S, Halbeisen FS, Seifert HH, Feicke A. Long-term outcome of non-antireflux robotic-assisted laparoscopic ureter reimplantation in ureteral obstruction. J Endourol 2022; 36:1183-1191. [PMID: 35262405 DOI: 10.1089/end.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Although robotic-assisted laparoscopic ureter reimplantation (RALUR) is a recognized alternative to open and laparoscopic ureter reimplantation in treating distal ureteral obstruction, there are limited data on long-term efficacy and safety outcomes of non-antireflux RALUR. We assessed patients undergoing RALUR, evaluating operative, functional and safety determinants. MATERIALS AND METHODS All consecutive patients undergoing non-antireflux RALUR between April 2015 and January 2020 were included in this retrospective cohort study. The primary outcome endpoint was recurrent distal ureteral obstruction. RESULTS Mean follow-up was 41.3 months (CI 95%, 33.3-49.2). Among the 26 included patients, none developed recurrent distal ureteral obstruction. Kidney function in terms of serum creatinine level (72.0 vs. 71.0 µmol/L, p=0.988) and glomerular filtration rate (92.0 vs. 91.0 mL/min, p=0.831) was stable between the preoperative period and the last follow-up. Renal pelvis dilatation decreased significantly postoperatively, from grade 2 to grade 0 (p<0.001). Most patients (73.1%) remained free from any clinical symptoms of reflux during the follow-up. The rate of postoperative complications (Clavien-Dindo grade ≥II) was 23.1%. All complications resolved without sequelae. No recurring urinary tract infections were reported. CONCLUSIONS Non-antireflux RALUR appears to be safe and effective in the management of distal ureteral obstruction. There was no recurrent ureteral obstruction after RALUR in our cohort during a mean follow-up of more than 3 years. Non-antireflux reimplantation did not seem to have any notable impact on renal function during the follow-up period.
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Affiliation(s)
- Kathrin Bausch
- University Hospital Basel, 30262, Department of Urology, Spitalstrasse 21, Basel, BS, Switzerland, 4031.,University Hospital Basel, 30262, Urology , Basel, Switzerland, 4031;
| | - Raphael Sauter
- Cantonal Hospital Basel-Landschaft, 367307, Liestal, Basel-Landschaft, Switzerland;
| | - Svetozar Subotic
- Cantonal Hospital Basel-Landschaft, 367307, Urology, Liestal, Basel-Landschaft, Switzerland;
| | | | - Hans H Seifert
- Universitätsspital Basel, 30262, Urology, Basel, Switzerland;
| | - Antje Feicke
- University Hospital Basel, 30262, Department of Urology, Basel, BS, Switzerland;
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Carbonara U, Crocerossa F, Mehrazin R, Campi R, Marchioni M, Morlacco A, Pagliarulo V, Wu Z, Autorino R, Stein RJ, Eun D, Ditonno P, Dal Moro F. Robotic ureteral reimplantation: systematic review and pooled analysis of comparative outcomes in adults. Minerva Urol Nephrol 2022; 74:161-168. [PMID: 35147383 DOI: 10.23736/s2724-6051.21.04558-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The surgical treatment of ureteral strictures in adults represents a challenging procedure for the variability of location, extension, and etiology of the disease. Open ureteral reimplantation (OUR) offered high success rates even when considering complex ureteral disease. The debate for defining the role of robotic in the treatment of adult ureteral disease is still ongoing. The aim of the current systematic review is to provide an updated analysis of the comparative outcomes of robot-assisted UR (RAUR) versus OUR based on the available literature. EVIDENCE ACQUISITION An independent systematic review of the literature was performed from 2010 to 2021. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design search strategies, selection criteria, and evidence reports. The quality of the included studies was determined using the Newcastle-Ottawa scale for nonrandomized controlled trials. Pooled analysis of demographics and clinical characteristics, as well as surgical and postoperative outcomes, was performed. EVIDENCE SYNTHESIS After an initial screening and full-text review, 5 studies published between 2002 and 2021 were identified and included in the analysis. All the studies were observational retrospective case-control studies. Among the 225 patients included in the pooled analysis, 94 (41.8%) and 131 (58.2%) were RAUR and OUR, respectively. There was no difference between groups in terms of baseline characteristics. No differences in surgical approach and operative time were reported among the groups. Estimated blood loss was lower for robotic approach (WMD: -121.71ml; p=0.0006). There were no significant differences between groups in overall (OR: 0.85; p=0.69) and major (OR:0.69; p=0.52) complication. RAUR group reported shorter length of stay (WMD: -2.39day; p<0.00001), catheter (WMD: -5.26day; p=0.004) and stent (WMD: -11.9day; p=0.001) time. CONCLUSIONS Available evidence shows that RAUR offers similar surgical outcomes if compared to OUR, and potential advantages in terms of lower blood loss, shorter hospital stay, catheter, and stent time. The adoption of one approach over the other is likely to be mainly dictated by the surgeon's preference and expertise.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA - u.carbonaragmail.com.,Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy - u.carbonaragmail.com
| | - Fabio Crocerossa
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy
| | - Alessandro Morlacco
- Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Vincenzo Pagliarulo
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China 11 Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Robert J Stein
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Pasquale Ditonno
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Fabrizio Dal Moro
- Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Hebert KJ, Linder BJ, Gettman MT, Ubl D, Habermann EB, Lyon TD, Ziegelmann MJ, Viers BR. Contemporary Analysis of Ureteral Reconstruction 30-Day Morbidity Utilizing the National Surgical Quality Improvement Program (NSQIP) Database: Comparison of Minimally Invasive Versus Open Approaches. J Endourol 2021; 36:209-215. [PMID: 34663084 DOI: 10.1089/end.2021.0242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007-2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS). Multivariable logistic regression was performed to observe the association of MIS approach on 30-day outcomes. RESULTS 3042 patients were identified with 2116 undergoing UUR and 926 undergoing LUR. Of 2116 patients undergoing UUR, 1733 (82%) were performed via MIS approach. On multivariable analysis, open approach for UUR was associated with increased odds of any 30-day complication (odds ratio (OR) 1.6 [1.1-2.4]; p=0.014), major complication (OR 1.8 [1.04-3.0]; p=0.034), transfusion (OR 3.7 [1.2- 11.5]; p=0.025), ROR (OR 2.0 [1.0-3.9]; p=0.047), and prolonged LOS (OR 5.4 [3.9-7.6]; p<0.001). Of the 926 patients undergoing LUR, 458 (49%) were performed via a MIS approach. On multivariable analysis, open approach for LUR was associated with increased odds of any 30-day complication (OR 1.5 [1.1-2.1]; p=0.028), minor complication (OR 1.7 [1.1-2.6]; p=0.02), transfusion (OR 8.1 [2.7-23.7]; p<0.001), and prolonged LOS (OR 4.2 [2.4-7.3]; p<0.001). CONCLUSION Utilization of a national surgical database revealed an open approach was associated with increased 30-day morbidity across multiple postoperative outcome measures. These findings suggest a MIS approach should be considered, when feasible, for upper and lower ureteral reconstruction.
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Affiliation(s)
- Kevin J Hebert
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel Ubl
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Yang K, Asghar AM, Lee RA, Strauss DM, Kuppa S, Lee Z, Metro M, Eun D. Robot-Assisted Laparoscopic Ureteroureterostomy for Distal Benign Ureteral Strictures with Long-Term Follow Up. J Endourol 2021; 36:203-208. [PMID: 34663087 DOI: 10.1089/end.2021.0315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To demonstrate feasibility of robot-assisted laparoscopic (RAL) ureteroureterostomy (UU) for benign distal ureteral strictures (DUS) in our robotic reconstruction series with long term follow up. PATIENTS & METHODS In a retrospective review of our prospectively maintained RAL ureteral reconstruction database, we followed patients between 6/2012-2/2019 who underwent a UU for DUS. In addition to patient demographics, we recorded the etiology, stricture length and recurrence rates. Recurrence was defined as findings of recurrent or persistent obstruction by postoperative mercaptoacetyltriglycine diuretic renal scan or the need for additional intervention with ureteral drainage or revisional surgery. RESULTS We identified 22 patients who underwent a RAL-UU for DUS of benign etiologies. Median age was 42 years old (IQR 39-57) and 20 of 22 patients (90.1%) were female. Median stricture length was 1.5 cm (IQR 1-2). Iatrogenic surgical injury was noted in 16 patients (73%). All ureteral reconstruction was performed using RAL. Post-operative imaging consisted of renal ultrasonography, diuretic renal scan or cross-sectional radiology within 3 months of the index operation. Further imaging was dependent on clinical judgment. Twenty patients (90.1%) had success with median follow-up time of 54.6 months with two recurrences necessitating RAL ureteroneocystostomy (UNC). CONCLUSION RAL-UU for DUS is technically viable and shows promising efficacy in properly selected patients. This technique may serve a niche for preserving the natural anatomical drainage of the bladder and ureter in addition to obviating the sequela of vesicoureteral reflux as seen in UNC.
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Affiliation(s)
- Kevin Yang
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
| | - Aeen M Asghar
- Temple University School of Medicine, 12314, Urology, 3401 N. Broad St, Philadelphia, Pennsylvania, United States, 19140;
| | - Randall A Lee
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
| | - David M Strauss
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
| | - Srikar Kuppa
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
| | - Ziho Lee
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
| | - Michael Metro
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
| | - Daniel Eun
- Temple University School of Medicine, 12314, Urology, Philadelphia, Pennsylvania, United States;
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Shakir NA, Zhao LC. Robotic-assisted genitourinary reconstruction: current state and future directions. Ther Adv Urol 2021; 13:17562872211037111. [PMID: 34377155 PMCID: PMC8326819 DOI: 10.1177/17562872211037111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
With the widespread dissemination of robotic surgical platforms, pathology previously deemed insurmountable or challenging has been treated with reliable and replicable outcomes. The advantages of precise articulation for dissection and suturing, tremor reduction, three-dimensional magnified visualization, and minimally invasive trocar sites have allowed for the management of such diverse disease as recurrent or refractory bladder neck stenoses, and radiation-induced ureteral strictures, with excellent perioperative and functional outcomes. Intraoperative adjuncts such as near-infrared imaging aid in identification and preservation of healthy tissue. More recent developments include robotics via the single port platform, gender-affirming surgery, and multidisciplinary approaches to complex pelvic reconstruction. Here, we review the recent literature comprising developments in robotic-assisted genitourinary reconstruction, with a view towards emerging technologies and future trends in techniques.
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Affiliation(s)
- Nabeel A Shakir
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, 222 41st Street, 11th Floor, New York, NY 10017, USA
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13
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Carbonara U, Branche B, Cisu T, Crocerossa F, Guruli G, Grob MB, Roseman T, Hampton LJ, Autorino R. ROBOT-ASSISTED URETERAL REIMPLANTATION: A SINGLE CENTER COMPARATIVE STUDY. J Endourol 2021; 35:1504-1511. [PMID: 34098751 DOI: 10.1089/end.2021.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To report a single-center experience with robot-assisted ureteral reimplantation (RAUR) and to compare its outcomes with those of open ureteral reimplantation (OUR). MATERIALS AND METHODS Patients who underwent RAUR or OUR for ureteral disease between 2016 and 2020 were identified. Data collected included baseline, pathological, perioperative and postoperative features. The RAUR outcomes were compared with those of OUR. RESULTS Overall, twenty-one (42.8%) patients underwent RAUR, and 28 (57.2%) underwent OUR. The two groups were similar in terms of baseline and pathological characteristics. There was a statistically significant difference in favor of RAUR for median operative time (216 vs. 317min, p=0.01) and median blood loss (35 vs. 175ml, p=0.001). No difference was observed in overall complication rate (33.3 vs. 46.4%, p=0.9), as well as major complications (Clavien-Dindo≥III grade) rate between RAUR and OUR groups. Median LOS was shorter for RAUR (2 vs. 6 days; p=0.001), as well as median catheterization time (16 vs. 28 days; p=0.005). CONCLUSIONS RAUR is a safe and effective minimally invasive surgical procedure for the management of mid to distal ureteral strictures. It can recapitulate the success rate of the gold standard OUR while offering a benefit in terms of lower surgical morbidity and faster postoperative recovery.
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Affiliation(s)
- Umberto Carbonara
- Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233.,Università degli Studi di Bari Aldo Moro, 9295, Department of Urology, Bari, Puglia, Italy;
| | | | - Theodore Cisu
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Fabio Crocerossa
- Virginia Commonwealth University Health System, 6887, Department of Urology, 1200 E Broad St., Richmond, Virginia, United States, 23298;
| | - Georgi Guruli
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Mayer B Grob
- VCU Health, 6887, Richmond, Virginia, United States;
| | - Tyler Roseman
- VCU Health, 6887, Richmond, Virginia, United States;
| | | | - Riccardo Autorino
- Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298;
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Abstract
PURPOSE OF REVIEW The purpose of this article is to outline the various therapeutic options of ureteral strictures. RECENT FINDINGS Ureteral strictures with consecutive hydronephrosis can be due to endourological and surgical procedures, inflammatory processes, radiation therapy as well as spontaneous passage of ureteral calculi. When planning surgical correction, stricture length, anatomical location as well as patients' characteristics like age, comorbidities and previous treatment in the peritoneal cavity, retroperitoneum or pelvis should be taken into consideration. Treatment options include not only surgical reconstruction techniques like simple stricture excision, end-to-end anastomosis, ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement, but also minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis. SUMMARY Various therapeutic options can be offered in the treatment of ureteral strictures, potentially leading to long-term success rate of more than 90% and a rate of significant complications < 5%.
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16
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Bansal D, Chaturvedi S, Maheshwari R, Kumar A. Role of laparoscopy in the era of robotic surgery in urology in developing countries. Indian J Urol 2021; 37:32-41. [PMID: 33850353 PMCID: PMC8033240 DOI: 10.4103/iju.iju_252_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/04/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.
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Affiliation(s)
- Devanshu Bansal
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
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17
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Asghar AM, Lee Z, Lee RA, Slawin J, Cheng N, Koster H, Strauss DM, Lee M, Reddy R, Drain A, Lama-Tamang T, Jun MS, Metro MJ, Ahmed M, Stifelman M, Zhao L, Eun DD. Robotic Ureteral Reconstruction in Patients with Radiation-Induced Ureteral Strictures: Experience from the Collaborative of Reconstructive Robotic Ureteral Surgery. J Endourol 2020; 35:144-150. [PMID: 32814443 DOI: 10.1089/end.2020.0643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Management of radiation-induced ureteral stricture (RIUS) is complex, requiring chronic drainage or morbid definitive open reconstruction. Herein, we report our multi-institutional comprehensive experience with robotic ureteral reconstruction (RUR) in patients with RIUSs. Patients and Methods: In a retrospective review of our multi-institutional RUR database between January 2013 and January 2020, we identified patients with RIUSs. Five major reconstruction techniques were utilized: end-to-end (anastomosing the bladder to the transected ureter) and side-to-side (anastomosing the bladder to an anterior ureterotomy proximal to the stricture without ureteral transection) ureteral reimplantation, buccal or appendiceal mucosa graft ureteroplasty, appendiceal bypass graft, and ileal ureter interposition. When necessary, adjunctive procedures were performed for mobility (i.e., psoas hitch) and improved vascularity (i.e., omental wrap). Outcomes of surgery were determined by the absence of flank pain (clinical success) and absence of obstruction on imaging (radiological success). Results: A total of 32 patients with 35 ureteral units underwent RUR with a median stricture length of 2.5 cm (interquartile range [IQR] 2-5.5). End-to-end and side-to-side reimplantation techniques were performed in 21 (60.0%) and 8 (22.9%) RUR cases, respectively, while 4 (11.4%) underwent an appendiceal procedure. One patient (2.9%) required buccal mucosa graft ureteroplasty, while another needed an ileal ureter interposition. The median operative time was 215 minutes (IQR 177-281), estimated blood loss was 100 mL (IQR 50-150), and length of stay was 2 days (IQR 1-3). One patient required repair of a small bowel leak. Another patient died from a major cardiac event and was excluded from follow-up calculations. At a median follow-up of 13 months (IQR 9-22), 30 ureteral units (88.2%) were clinically and radiologically effective. Conclusion: RUR can be performed in patients with RIUSs with excellent outcomes. Surgeons must be prepared to perform adjunctive procedures for mobility and improved vascularity due to poor tissue quality. Repeat procedures for RIUSs heighten the risk of necrosis and failure.
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Affiliation(s)
- Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Randall A Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jeremy Slawin
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - David M Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rohit Reddy
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Alice Drain
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Tenzin Lama-Tamang
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Min S Jun
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Michael J Metro
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Michael Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Lee Zhao
- Department of Urology, New York University, Langone Medical Center, New York City, New York, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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[Application of indocyanine green in complex upper urinary tract repair surgery]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52. [PMID: 32773795 PMCID: PMC7433627 DOI: 10.19723/j.issn.1671-167x.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the clinical application of indocyanine green (ICG) visualization by near infrared fluorescence laparoscopy (NIFL) in complex upper urinary tract reconstructions surgery. METHODS This was a retrospective study of 7 patients who underwent complex surgeries of ureteral reconstruction between May 2019 and October 2019. There were 6 males and 1 female with the age ranging from 24 to 57 years (median age was 47 years). There were 5 cases of right ureteral strictures, of which 3 were proximal ureteral strictures and 2 were multiple and long ureteral strictures caused by radiotherapy. There were 2 cases of left ureteral strictures, of which 1 was ureteropelvic junction stricture and 1 was proximal ureteral stricture. There were 4 cases of secondary repair operations and 3 cases of primary operations. All the patients underwent laparoscopic surgery via the abdominal approach. ICG was injected into the ureter via nephrostomy tube during the operations, and the diseased ureter was identified by NIFL. Among the patients, 2 cases underwent IUPU (Institute of Urology, Peking University) modified ileal ureter replacement, 2 cases underwent ureteroureterostomy, 2 cases underwent appendiceal onlay flap ureteroplasty, and 1 case underwent lingual mucosa onlay flap ureteroplasty. RESULTS All the operations were successfully completed without open conversion. The localization and separation of ureteral lesions were completed under NIFL. The mean operative time was 187 (135-300) min. The duration of ureteral separation was 15-27 min, and the mean time was 18 min. The estimated blood loss was 15-200 mL, the mean estimated blood loss was 50 mL. There was one patient with ileal ureter replacement who had fever after surgery and responded well to antibiotics. The mean (range) length of postoperative hospital stay was 7 (6-10) days and no postoperative complications of a high grade (Clavien-Dindo Ⅲ and Ⅳ) occurred. Up to now, the mean follow-up duration was 9 (6-11) months, and no indocyanine green toxicity occurred. All D-J stents and nephrostomy were removed successfully 2 months after the operation. Ultrasound showed no obvious hydronephrosis, and CTU (computed tomography urography) showed that the urinary tract was unobstructed and the kidney function was normal. CONCLUSION The application of ICG in the complex upper urinary tract reconstructive surgery is a safe and easy method to help surgeon to identify the ureter which may reduce the risk of iatrogenic damage and protect the ureteral blood supply.
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Kim S, Fuller TW, Buckley JC. Robotic Surgery for the Reconstruction of Transplant Ureteral Strictures. Urology 2020; 144:208-213. [PMID: 32645371 DOI: 10.1016/j.urology.2020.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To demonstrate the feasibility and success of a robotic approach to reconstruction of ureterovesical anastomotic strictures in kidney transplants. MATERIALS AND METHODS Between November 2017 and December 2019, a total of 5 patients with transplant ureteral stricture were identified and treated with robot assisted laparoscopic repair. All patients were confirmed to have ureteral stricture with a preoperative antegrade nephrostogram through their nephrostomy tube and cystogram. The patients demographics, ureteral characteristics, type of procedure, and outcomes are reported. RESULTS All patients were diagnosed after evaluation for renal deterioration. The average age of the patients was 49 years old. The average stricture length was 2.5 cm, and the location was variable, though more commonly in the distal ureter. Three patients required a pyelo-vesicostomy, while 2 required a ureteroneocystostomy. The mean length of stay was 2.2 days. Average follow-up was 97 days, with all 5 patients having successful outcomes, no strictures or delayed leaks were identified. There were no wound infections or readmissions within 30 days. CONCLUSION Though a complex repair, the robot-assisted approach to transplant ureter reconstruction using either an end to side neoureterocystotomy or direct pyelo-vesicotomy is technically feasible and successful. Given the many advantages inherent in comparison to an open approach, the robotic repair offers significant advantages to both the patient and the surgeon who is experienced with robotic surgery and reconstructive principles.
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Affiliation(s)
- Sunchin Kim
- Department of Urology, The University of California, San Diego, San Diego, CA.
| | - Thomas W Fuller
- Department of Urology, Virginia Mason Medical Center, Seattle, WA
| | - Jill C Buckley
- Department of Urology, The University of California, San Diego, San Diego, CA
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20
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Affiliation(s)
- Kwangsung Park
- Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea
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