V03-09: Right Robotic Intracorporeal Ileal Ureter with Single-Position Port Placement Using da Vinci Xi®

Video

INTRODUCTION

Management of long ureteral strictures is a challenge in reconstructive urology, with limited options that include ileal ureter, autotransplant, or nephrectomy. Minimally-invasive ileal ureter was first described in 2000, with the first robotic case published in 2008. We present a 41-year-old woman with a right pan-ureteral stricture of unknown etiology, who failed ureteral stent management and was nephrostomy tube dependent. We describe a port placement that allows for completion of the entire operation using the Intuitive da Vinci Xi® and Trumpf TruSystem® 7000dV with Table Motion.

METHODS

Patient was placed in the left lateral decubitus position. Four robotic ports were placed at the following locations (Figure): (1) 8 mm subcostal port for the right arm (2) 8 mm supra-umbilical port for the camera (3) 8 mm peri-umbilical port for left arm and (4) 8 mm infra-umbilical port for the fourth arm. A 12 mm assistant port was placed medial to the camera. The table was initially tilted to the left 13 degrees, with flexion. Colon and duodenum were mobilized exposing Gerota&[prime]s fascia. The proximal ureter and renal pelvis were isolated. The table was then tilted back to 0 degrees with Trendelenburg position using Table Motion to allow pelvic dissection and complete the ileal portion of the operation. The bladder was mobilized and a psoas hitch was performed. We placed an additional 12 mm port in the ipsilateral lower quadrant to complete the entero-enterostomy. The ileaovesical anastomosis was performed followed by the pyeloileal anastomosis. Drainage included a capped nephrostomy tube, ureteral stent, foley catheter, and an abdominal drain.

RESULTS

Total robot operative time was 335 minutes. Estimated blood loss was 30 ml. The length of hospital stay was 4 days and patient was discharged home without complication. Foley catheter and ureteral stent were removed at 2 and 5 weeks, respectively. Her nephrostomy tube remained capped for 2 additional weeks. Antegrade nephrostogram demonstrated patency of both anastomoses, so the nephrostomy tube was removed.

CONCLUSION

Robotic ileal ureter is a feasible operation with acceptable morbidity for patients with long ureteral strictures. Using a da Vinci Xi® and TruSystem® 7000dV with Table Motion allows for a seamless surgery to limit operative time and surgical delays in select scenarios.

Funding: None