V12-11: Robotic Ileal Ureter: Step by Step
VideoIntroductions and Objectives
Ureteral strictures may result from a variety of causes. I's incidence has increased in recent years due to the use of upper urinary tract endoscopy. There is limited data to date within the literature describing the use of robotics for ileal ureter. Herein, we describe step-by-step our technique for intracorporeal robotic ileal ureter.
The patient will undergo two position changes throughout the entire procedure. The patient will begin in the flank position, be repositioned in supine lithotomy, and finally the procedure will end with the patient once again in the flank position._x000D_ _x000D_ There are 7 main surgical steps for our robotic ileal ureter procedure: _x000D_ o Colonic mobilization from the iliac vessels up to the hepatic/splenic flexure._x000D_ o Identification of the ureter, gonadal vein, renal hilum, and measuring the length of the ureter._x000D_ o Isolation and division of a segment of ileum about 25 cm above the ileocecal valve to be used for the ureter. _x000D_ o Side to side bowel anastomosis._x000D_ o If doing a left ileal ureter, a window is formed between the sigmoid and the sacrum up to the transition between the sigmoid and left descending colon for the ileal ureter to travel below the sigmoid and descending colon. This step is unnecessary for a right ileal ureter._x000D_ o Anastomosis of the distal ileal ureter to the bladder and placement of a double-J stent from the distal to the proximal part of the ileal loop._x000D_ o Incision of the renal pelvis and side-to-side anastomosis between the ileal segment and renal pelvis.
We have successfully performed this procedure robotically on three patients. The results from the procedures are listed in the Table.
We describe our step-by-step technique for robotic completely intracorporeal creation of an ileal ureter. Initial experience demonstrates this to be a feasible operation.