Robot-assisted laparoscopic ureteral reconstruction: а systematic review of literature

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.

Laparoscopic onlay lingual mucosal graft ureteroplasty combined with ureterovesical reimplantation for one-stage reconstruction of complex ureteral strictures: a case report

The treatment of ureteral stricture is a challenging task, especially when multiple strictures are present. Here, we report on a 63-year-old male patient diagnosed with hydronephrosis with left ureteral strictures who was admitted to our hospital. During treatment, a left percutaneous nephrostomy tube was inserted for hydronephrosis. Antegrade and retrograde pyelography were performed simultaneously. The results suggested there were 3 segment ureteral strictures in the left ureter: 2 located in the distal ureter and 1 in the proximal ureter. The treatment choices for multiple ureteral strictures are kidney autotransplantation or an ileal ureteral replacement (IUR), which are both morbid procedures and are technically challenging. With the excellent results of lingual mucosal graft (LMG) in ureteroplasty, this patient underwent a one-stage left ureter reconstruction with combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation. However, disease of the oral mucosa and a reduced bladder volume caused by radio cystitis or chemical cystitis, may limit the use of this technique. Regular postoperative antegrade pyelography and the Whitaker test showed the unimpeded drainage of the left ureter. Based on the satisfactory outcome of this patient, combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation for unilateral multiple ureteral strictures is a viable option that has fewer complications.

[A retrospective comparison of robotic assisted and conventional laparoscopic pyeloplasty in two centres]

Ziel

Wir verglichen in unserer retrospektiven Multicenterstudie die Ergebnisse der konventionell laparoskopischen Nierenbeckenplastik (L-NBP) mit denen der roboterassistierten Nierenbeckenplastik (R-NBP) nach Einführung des da Vinci X-Systems.

Methoden

Insgesamt wurden im definierten Zeitraum von Mai 2015 bis September 2019 76 Nierenbeckenplastiken an zwei unterschiedlichen Universitätskliniken durchgeführt. Für die Datenanalyse wurden 63 Patienten berücksichtigt, welche entweder eine L‑NBP (n = 27) oder eine R‑NBP (n = 36) nach Anderson und Hynse erhielten.

Ergebnisse

Das mediane Follow-up lag bei 22,5 (L-NBP) bzw. 12,7 (R-NBP) Monaten. Die statistische Analyse der Patientengruppen ergab bzgl. Alter, BMI, Geschlecht und betroffener Seite keinen statistischen Unterschied. Die Operationszeit war in der Gruppe der R‑NBP nicht statistisch signifikant kürzer (180 ± 72 vs. 159 ± 54 min, p = 0,194). Bezüglich postoperativer Major- bzw. Minor-Komplikationen nach Clavien-Dindo, Krankenhausaufenthaltsdauern (7,48 ± 2,86 vs. 6,33 ± 2,04 Tage) und Erfolgsrate ergab sich ebenso kein statistisch signifikanter Unterschied.

Schlussfolgerung

Unsere Daten zeigen keinen signifikanten Unterschied der beiden Gruppen bezogen auf die peri- und postoperativen Ergebnisse. Es konnte gezeigt werden, dass für den Patienten auch unmittelbar nach Implementierung eines robotischen Systems kein Nachteil entsteht.

Subtotal ureteral substitution with ileum for patients with multiple ureteral stenosis

The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive approach. To date, this technique required a complete substitution of the ureter with ileum. In this work we present our robotic intracorporeal sub-total ureteral substitution preserving the distal part of the ureter with the aim to reduce the risk of vescico-ureteral reflux. We report the case of a 65-years old male with a “functional” right single kidney and multiple recurrent stenosis. Our technique seems to be feasible and safe, no intra or postoperative complication were recorded. At 3 months of follow-up the trans-nephrostomic enhanced CT showed a completely opacification of ileal ureter, thus the nephrostomic tube was removed. At 6 and 12 months the patient was asymptomatic and with a level of serum creatinine 1.9 and 1.6 mg/dL, respectively. In conclusion the sub-total ureteral substitution with ileum can be a safety and effective procedure for patients who require a mandatory preservation of homolateral renal function.

Robot-assisted distal ureteral reconstruction for benign pathology: Current state

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.