V11-04: Robot-assisted Ureterolysis in Extrinsic Stricture of the Left Ureter Caused by a Lipoleiomyoma of the Ovary.
VideoIntroductions and Objectives
Robotic surgery not only is an excellent tool in radical prostatectomy and partial nephrectomy, but also in ureteric surgery. In open surgery ureterolysis is accompanied by a long cutaneous incision and a remarkable long recovery time. Conventional laparoscopy offers no three dimensional sight and is limited in freedom of movement. Robotic surgery makes easier the preparation, excision and anastomosis of the ureter.
The patient was positioned in a 45 degree Trendelenburg position. Four robotic trocars and two assistant trocars were used similar to radical prostatectomy. Through a transperitoneal approach the ureter was freed from scarry tissue 2 to 4 cm prevesically resecting the benign ovarial tumor partially. The ureter was secured by interposition of TachoSil®.
Within eight months kidney function of the operated side improved: Preoperative radioisotope renography (Tc99m-MAG3) showed urinary excretion of 152.0 ml/min on the right side (80.3% of the overall kidney function) and 37.2 ml/min (19.7%) on the left side. Postoperatively it showed 166.1 ml/min. (74%) on the right side and 58.3 ml (26%) on the left side. Recovery was uneventful.
Due to the known advantages, the robotic approach in ureteric surgery is a safe and effective method and seems to be superior to other methods especially in difficult cases.