1
|
Shrivastava N, Bhargava P, Jain P, Choudhary GR, Jena R, Singh M, Navriya S, Madduri VKS, Bhirud DP, Sandhu AS. Robot-assisted ureteric reconstructive surgeries for benign diseases: Initial single-center experience with point of technique. Urologia 2024; 91:357-363. [PMID: 38345047 DOI: 10.1177/03915603241229144] [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: 05/31/2024]
Abstract
INTRODUCTION We present our initial experience with robot-assisted reconstructive surgeries with the Da Vinci Xi robotic system for benign ureteric pathologies. MATERIALS AND METHODS This is a retrospective review of prospectively collected data of patients who underwent robot-assisted reconstructive procedures for benign diseases of the ureter at our department from April 2018 to November 2022. Demographic and perioperative details were recorded. Patients were followed up and surgical success was evaluated on the basis of symptomatic, functional, and radiological improvement. RESULTS A total of 34 patients underwent robot-assisted reconstructions for benign ureteric pathologies by various techniques. Mean age, body mass index (BMI), hospital stay and follow-up duration were 36 years, 24.1 kg/m2, 5.29 days, and 7.08 months respectively. Procedures included pyeloplasty in eight, primary ureteroneocystostomy (UNC) in seven, Psoas hitch UNC in five, Boari flap UNC in six, Ureteroureterostomy in four, ureterocalicostomy in two and ileal ureteral transposition in two patients. Mean docking time, total operative time, and estimated blood loss were 31.5 min, 178 min, and 64.3 ml, respectively. All patients had radiologic or functional improvement on follow-up after 6 months. CONCLUSION Robot-assisted reconstructive surgery for benign ureteric and bladder pathologies imparted excellent short-term outcomes without major complications with all the advantages of a minimally invasive approach.
Collapse
Affiliation(s)
- Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyank Bhargava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pritesh Jain
- Department of Urology, Preksha Hospital, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shivcharan Navriya
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
2
|
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.
Collapse
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;
| |
Collapse
|
3
|
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.
Collapse
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;
| |
Collapse
|
4
|
Elbers JR, Rodríguez Socarrás M, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG. Robotic Repair of Ureteral Strictures: Techniques and Review. Curr Urol Rep 2021; 22:39. [PMID: 34105032 DOI: 10.1007/s11934-021-01056-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. RECENT FINDINGS The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.
Collapse
Affiliation(s)
- Javier Reinoso Elbers
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Moises Rodríguez Socarrás
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain.
| | - Juan Gómez Rivas
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Ana Maria Autran
- Oficina de Investigacion CAU (Confederacion Americana de Urologia), Madrid, Argentina
| | | | | | - Diego M Carrion
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| | - Fernando Gómez Sancha
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª Planta, 28034, Madrid, Spain
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Asghar AM, Lee RA, Yang KK, Metro M, Eun DD. Robot-assisted distal ureteral reconstruction for benign pathology: Current state. Investig Clin Urol 2019; 61:S23-S32. [PMID: 32055751 PMCID: PMC7004836 DOI: 10.4111/icu.2020.61.s1.s23] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022] Open
Abstract
Distal ureteral reconstruction for benign pathologies such as stricture disease or iatrogenic injury has posed a challenge for urologist as endoscopic procedures have poor long-term outcomes, requiring definitive open reconstruction. Over the past decade, there has been an increasing shift towards robot-assisted laparoscopy (RAL) with multiple institutions reporting their outcomes. In this article, we reviewed the current literature on RAL distal ureteral reconstruction, focusing on benign pathologies only. We present peri-operative data and outcomes on the most common technique, ureteral reimplantation, as well as adjunct procedures such as psoas hitch and Boari flap. Additionally, we present alternative techniques reported in the literature with some technical considerations. Lastly, we describe the outcomes of the comparative studies between open, laparoscopy, and RAL. Although the body of literature in this field is limited, RAL reconstruction of the distal ureter appears to be safe, feasible, and with some advantages over the traditional open approach.
Collapse
Affiliation(s)
- Aeen M Asghar
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Randall A Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Kevin K Yang
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Michael Metro
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Daniel D Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| |
Collapse
|
7
|
Dirie NI, Wang S. Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review. Asian J Urol 2019; 7:37-44. [PMID: 31970070 PMCID: PMC6962745 DOI: 10.1016/j.ajur.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/19/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022] Open
Abstract
Objective To present our experience and technique with robot-assisted ureteroneocystostomy (RAUN) procedure in adults. Methods Between February 2015 and August 2018, a total of 30 (34 ureters) patients who underwent RAUN surgery under a single surgeon were retrospectively reviewed. Perioperative data such as age, sex, body mass index (BMI), American society of anesthesiologists score, estimated blood loss, surgical technique, operative time, complications, length of hospital stay, and stent removal time were recorded. During the follow-up, patients underwent renal function test, urinalysis, and renal ultrasound examination for evaluation. Success was defined as symptomatic and radiologic relieve. Lastly, a literature search was conducted to review all published articles regarding RAUN surgery in adults. Results The patients’ mean age, BMI, EBL, operative time, and follow-up period were 45.4 years, 23.1 kg/m2, 65.6 mL, 182.9 min, and 21.3 months, respectively. The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondary to a previous radical hysterectomy. Of the 34 cases, 26 (76.5%) and 8 (23.5%) patients received primary RAUN and RAUN with psoas hitch technique, respectively. Refluxing RAUN method was performed in all cases. No intraoperative complications were found. Two patients had a radiologic and symptomatic recurrence; one was managed with a repeat surgery while the other received ureteral dilatation treatment. Conclusion Both our study and the published literature showed that RAUN is a safe, less invasive, and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.
Collapse
Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
8
|
Kolontarev K, Kasyan G, Pushkar D. Robot-assisted laparoscopic ureteral reconstruction: а systematic review of literature. Cent European J Urol 2018; 71:221-227. [PMID: 30038814 PMCID: PMC6051367 DOI: 10.5173/ceju.2018.1690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/16/2018] [Accepted: 04/21/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction To review the literature, as well as to analyze and compare available data on robot-assisted laparoscopic (RAL) surgery versus open surgery, carried out in ureteral reconstructions in terms of different surgical characteristics. Materials and methods Eligible studies, published between 1997 and July 2016, were retrieved through MEDLINE by applying predetermined inclusion and exclusion criteria with the English language restriction. Publications on RAL surgeries, carried out in different ureteral reconstructions and of any study design, including case series and comparative studies, were included. The study was performed in accordance with the PRISMA statement. Results A total of 12 retrospective studies (case series and comparative studies) met the systematic review selection criteria involving 245 RAL and 76 open ureteral surgery cases. Main indications for ureter reconstruction were strictures, tumors and injuries. The individual results of comparative studies revealed that the EBL was statistically significantly lower for RAL than for open surgery. As for operation time, length of hospital stay and follow-up time, the data was contradictory. The rate of recurrent stricture in RAL and open groups was similar: -9.0%. The meta-analysis of three comparative studies confirmed that patients lose statistically significantly less blood in RAL, compared to open surgery. Conclusions The analysis of limited data available shows that robot-assisted laparoscopic ureteral reconstruction is a safe and effective minimally invasive technique with high cure rates similar to those of the conventional open approach and, with favorable safety profile. Future well-designed randomized controlled trials are required to strengthen our findings.
Collapse
|
9
|
Waldorf B, Lee Z, Kidd L, Kaplan J, Harris A, Metro M, Liu J, Eun D. Robotic Buccal Ureteroplasty: a Review of the Current Literature. Curr Urol Rep 2017; 18:40. [PMID: 28401476 DOI: 10.1007/s11934-017-0683-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW This study aimed to provide an overview of the literature on buccal mucosal ureteroplasty for ureteral stricture disease, with a specific focus on the application of the robotic platform to buccal ureteroplasty. RECENT FINDINGS In our review, we highlight the results of Zhao et al. from the New York University School of Medicine Department of Urology, as well as our own results from Temple University Hospital. Zhao et al. published the first series of four patients who underwent robotic buccal ureteroplasty. Mean stricture length was 3.0 cm, and at a mean follow-up of 15 months, all repairs remained patent. We also describe our results in 10 patients who underwent robotic buccal ureteroplasty at Temple University Hospital. Median stricture length was 3.0 cm, and at a median follow-up of 5 months, all repairs remain patent. Robotic buccal ureteroplasty offers a promising option for repair of complex ureteral strictures.
Collapse
Affiliation(s)
- Benjamin Waldorf
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
| | - Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Laura Kidd
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Joshua Kaplan
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Andrew Harris
- Paul B. Hall Regional Medical Center, Paintsville, KY, USA
| | - Michael Metro
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jeffrey Liu
- Temple Head and Neck Institute, Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
10
|
Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model. World J Urol 2016; 35:89-96. [PMID: 27151276 DOI: 10.1007/s00345-016-1840-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/27/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. MATERIALS AND METHODS Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9 weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. RESULTS All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162-360). Flap tubularization suture took 31 min (19-47), and proximal anastomosis took 20 min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7-12) and 23 min (13-46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p = 0.003). CONCLUSIONS Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.
Collapse
|
11
|
Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review. J Endourol 2014; 29:124-36. [PMID: 25100183 DOI: 10.1089/end.2014.0522] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.
Collapse
Affiliation(s)
- Stavros I Tyritzis
- 1 Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden
| | | |
Collapse
|
12
|
Lee Z, Moore B, Giusto L, Eun DD. Use of indocyanine green during robot-assisted ureteral reconstructions. Eur Urol 2014; 67:291-8. [PMID: 25220372 DOI: 10.1016/j.eururo.2014.08.057] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although there are reports of robot-assisted ureteral reconstructions (RURs) with excellent safety and efficacy, the procedures remain technically challenging. In the robotic setting the surgeon must rely on visual cues in the absence of tactile feedback. Indocyanine green (ICG) is a dye that can be visualized under near-infrared fluorescence (NIRF). OBJECTIVE To describe our novel technique, which utilizes intraureteral injection of ICG and subsequent visualization under NIRF to facilitate RUR, and report our outcomes after these procedures. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective review of 25 patients who underwent 26 RURs for various ureteral pathologies between June 2012 and October 2013. SURGICAL PROCEDURE After full disclosure, all patients consented to off-label use of ICG. A ureteral catheter and/or percutaneous nephrostomy tube were used to inject 10ml of ICG into the diseased ureter, above and below the stricture. Intraoperatively, NIRF was activated to assist in identification of the ureter and to localize the margins of ureteral strictures. MEASUREMENTS Postoperatively, RURs were assessed for clinical success (absence of symptoms attributable to ureteral pathology) and radiological success (absence of a ureteral stricture on imaging). RESULTS AND LIMITATIONS Our technique provided visual cues and aided in successful performance of 26 RURs in 25 patients. The procedures included ureterolysis (n=4), pyeloplasty (n=8), ureteroureterostomy (n=9), and ureteroneocystostomy (n=5). There were no perioperative complications attributable to ICG use. At a mean overall follow-up of 12 mo, all procedures were clinically and radiologically successful. This study is limited by the small sample size and short-term follow-up. CONCLUSIONS Intraureteral injection of ICG and subsequent visualization under NIRF facilitates RUR by aiding in rapid and accurate identification of the ureter, and precise localization of the proximal and distal ureteral stricture margins. In our experience, our technique is safe, easy to perform, and reproducible. PATIENT SUMMARY In this report, we describe a new technique to facilitate robot-assisted ureteral reconstructions using intraureteral injection of ICG and subsequent visualization under near-infrared fluorescence. More specifically, our technique allows for rapid and accurate identification of the ureter, and precise localization of ureteral strictures.
Collapse
Affiliation(s)
- Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Blake Moore
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Laura Giusto
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|