V10-09: Tips for Surgical Technique During Robotic Ureteral Reconstruction for Various Segments of Ureter
Ureteral reconstruction for different segments of ureter can be extremely challenging. There are many methods for reconstruction, most of which are typically performed using an open approach. Standard techniques such as boari flap and psoas hitch have been around for many years and are traditionally not performed using a minimally invasive approach. In this video we present multiple advanced techniques and alternatives during robotic ureteral reconstruction for various segments of ureter.
We present techniques for distal ureterectomy with reimplantation, segmental ureterectomy with end to end anastomosis, buccal mucosal patch and ileal patch for midureteral stricture, and ileal ureteral replacement for panureteral stricture. We demonstrate these techniques as well as the use of indocyanine green injection to help with identification of the level of obstruction.
To date, 24 cases of ureteral reconstruction have been performed. Robotic console times have ranged form 60 minutes to 194 minutes. Estimated blood loss has ranged from 10-150ccs. Length of stay has ranged from 1-4 days. Follow up has ranged from 2-60 months. To date, there is no evidence of recurrent obstruction in any patient.
Robotic ureteral reconstruction can be successfully performed on any segment of ureter and is a feasible option to more invasive open surgery. The use of indocyanine green can help delineate segments of ureter for excision. Ileal and buccal patches are good alternatives to segmental ureterectomy or more complicated flaps for midureteral strictures.