V11-12: Robot-assisted Laparoscopic Distal Tumor-Ureterectomy, Psoas Hitch and Boari-Flap Ureteral Reconstruction.

Video

Introductions and Objectives
Reconstruction of the lower ureter can be achieved by a Boari-flap either by open surgery or a laparoscopic procedure. Robot assisted surgery offers multiple intraoperative advantages including wristed movements with additional degrees of freedom and three dimensional visualization with magnification. The video shows a robot-assisted approach for ureteric resection according to a malignant ureteral tumor, the creation of a Boari-flap and the ureteral reimplantation.

Methods
We used 4 robot and 2 assistant trocars similar to radical cystectomy in a 10 degree Trendelenburg position. The distal ureter (10cm) was resected, the distal part of the remaining ureter sent for frozen section. After filling the bladder with saline, the Boari-flap was created and fixed at the psoas-fascia in a psoas-hitch manner. Then the antirefluxive ureteral reimplanatation was performed intraabdominally.

Results
Recovery was uneventful. Histologic examination of the specimen revealed a transitional carcinoma of the ureter pT2, high grade, R0 L0 V0. There was no leakage at the time of removal of the ureteric splint on the 10th postoperative day. Follow up at 14 months showed no recurrence of the tumor.

Conclusions
Robot assisted oncological surgery of ureter and bladder is a safe and effective alternative to open and conventional laparoscopic surgery. It offers fast and uncomplicated recovery, minimal blood loss and optimal cosmesis.

Funding: None