V2163: Robotic Repair of Post-Cystectomy Ureteroileal Anastomotic Strictures: Techniques for Success
VideoIntroduction and Objectives
Post-cystectomy ureteroileal anastomotic strictures that fail percutaneous or endourologic management require operative repair. These cases can be challenging and few reports of robotic repairs exist in the available literature. The objective of this study is to describe a stepwise approach to robotic surgical repair of ureteroileal strictures.
Four patients with a mean age of 72 underwent this procedure at our institution, including two with left-sided strictures and two with right-sided strictures. Three of the four patients had undergone prior abdominal surgery in addition to their cystectomy. All patients failed initial percutaneous and/or endourologic attempts to resolve their stricture.
The ureteroileal strictures were successfully repaired robotically in all cases. The most challenging case (presented in the video) included a long left-sided stricture requiring extensive mobilization of the left ureter prior to reimplantation into the ileal conduit. The primary techniques to achieve this included dissection of the colonic mesentery, careful peeling of the ureter off of the common iliac vessels, and mobilization of the ureter on either side of the sigmoid colon. With mean follow up of 16 months no major complications were encountered and all patients remain free of stricture recurrence to date.
Robotic ureteroileal anastomotic stricture repair is feasible for both right and left-sided cases. A similar operative approach can be used regardless of stricture side.