V02-03: Application of Robotic Assistance to Transplant Ureteroneocystostomy
Urologists are called upon to assist in management of ureteral strictures following renal transplantation. Refractory strictures can be managed with surgical reconstruction by performing ureteroneocystostomy or pyelovesicostomy. Transplant ureteroneocystostomy is often performed using an open approach. Challenges inherent to this surgery including periureteral fibrosis can be tackled with a robotic approach using advances in robotic surgical tools. Here we demonstrate our technique and rationale for performing robotic-assisted transplant ureteroneocystostomy in select patients.
We present a single surgeon's initial case series of three patients who underwent transplant ureteroneocystostomy using the daVinci® robotic surgical system, as well as discuss what influences determination of a patient's candidacy for this approach.
Three patients with transplant ureteral strictures were identified. The median age was 61 years (26-62 years). All 3 patients failed attempts at stricture dilation. The median time from transplantation to robotic transplant ureteroneocystostomy was 7 months (6-19 months). All three patients underwent uncomplicated robotic transplant ureteroneocystostomy and were discharged on postoperative day one. All patients underwent removal of all urinary drainage tubes (foley catheter, ureteral stent, and nephrostomy tube) postoperatively in a staged fashion. At a median follow up of 11 months (3-14 months), none of the patients had evidence of hydronephrosis or renal obstruction.
Use of the robotic approach to transplant ureteroneocystostomy is a feasible alternative to a procedure previously done through an open Gibson incision. Performing this surgery in a minimally-invasive fashion has potential benefits of expediting postoperative recovery and minimizing wound-related complications in this immunosuppressed patient population. When applied to carefully selected patients, robotic-assisted transplant ureteroneocystostomy is a useful tool to treat transplant ureteral strictures.