V10-07: Robotic repair of right uretero-ileal anastomotic stricture following prior robotic radical cystectomy and intracorporeal conduit diversion
Uretero-ileal anastomotic stricture is a well-known complication following radical cystectomy and urinary diversion with a rate of 8-12% in open and robotic series. Some strictures can be managed endoscopically but many require revision of the uretero-ileal anastomosis. With increased utilization of robotic radical cystectomy we have started revising these strictures with a robotic approach as well.
From September 2014 - October 2016 we have performed 75 robotic radical cystectomies with 60 undergoing robotic intracorporeal ileal conduit urinary diversion._x000D_ We found 6 patients that developed a uretero-ileal stricture. In the following video we highlight the technique for robotic revision of a right-sided uretero-ileal anastomotic stricuture in a patient following prior robotic radical cystectomy and intracorporeal ileal conduit urinary diversion.
Our uretero-ileal anastomotic stricture rate following robotic radical cystectomy with intracorporeal conduit urinary diversion was 10%. _x000D_ Of these four were involving the left and two were involving the right ureter. Three patients were able to be managed with endoscopic dilation_x000D_ and three patients required revision of their uretero-ileal anastamotic stricture. All 3 patients were able to be managed with robotic uretero-ileal anastomotic revision._x000D_ Mean time to diagnosis of stricture was 182 days. For the patient in the video operative time was 62 minutes, EBL was 100cc, and length of stay was 1 day. The other two patients had other concomitant operations (parastomal hernia repair in one and takedown of pre-existing colon conduit in another) that significantly impacted operative time and length of stay and were not including in analysis of perioperative outcomes.
Uretero-ileal anastomotic strictures following robotic radical cystectomy and intracorporeal conduit urinary diversion can safely and effectively be managed with a robotic approach.