V10-11: Intracorporeal Robotic-Assisted Laparoscopic Appendiceal Interposition for Ureteral Stricture Disease
Management of complex ureteral strictures greater than 1 cm in length are traditionally treated with open or laparoscopic ureteral reconstruction. In the setting of long segment strictures not amenable to simple ureteroureterostomy, ureteral replacement with ileum classically has been described as a suitable option. Aside from ileum, a buccal mucosa graft and the appendix have been described as alternative replacement tissues. To date, there are no reports in the literature of a robotic-assisted laparoscopic (RAL) ureteral reconstruction utilizing the appendix. We report, to our knowledge, the first case of a completely intracorporeal RAL appendiceal interposition for ureteral stricture disease in a 33 year old Caucasian male with a 5 cm obliterative right-sided ureteral stricture secondary to recurrent urolithiasis.
The DaVinci Xi was docked to the patient in a fashion comparable to right nephroureterectomy. Extensive renal descensus was performed and it was determined that tension-free primary ureteroureterostomy was not feasible. Given the ideal position, length and orientation of the appendix, along with the added morbidity of bowel harvest, we elected to perform an appendiceal interposition. The appendix with its mesentery was isolated and interposed between the remaining healthy proximal and distal ends of the ureter. The ureteroappendiceal anastomoses were performed in an end-to-end fashion. A ureteral stent was left in place to allow for postoperative healing. The entire case was done intracorporeally.
The ureteral stent was removed two weeks postoperatively. Antegrade nephrostogram showed patency of the ureter down to the bladder one month postoperatively. Lasix renal scan confirmed preservation of renal function and no obstruction three months postoperatively.
In carefully selected patients with long-segment right-sided ureteral strictures and favorable anatomy, appendiceal interposition is a good option for ureteral reconstruction. This procedure can be done safely and effectively with robotic-assistance._x000D_