V4-03: Minimally Invasive, Robotic Ureteral Surgery: An Illustrated Techniques Video

V4-03: Minimally Invasive, Robotic Ureteral Surgery: An Illustrated Techniques Video


Introductions and Objectives
Over the past decade, the use of robotic surgery has become more widespread in urology for multiple applications. Ureteral strictures have a multitude of etiologies including malignancy, ischemia due to prior surgical dissection, endoscopic instrumentation, ureteral calculi, and radiation. Management of benign ureteral stricture disease is determined by the length and location of disease. Reconstruction may be required if endoscopic management fails or will not suffice. Minimally-invasive, robotic-assisted surgical techniques lend themselves well to ureteral repair and reconstruction given that anastomoses are greatly simplified with robotic assistance when compared to a pure laparoscopic approach. Herein, we provide a video-based illustration of the techniques for robotic ureteral reconstruction, namely ureteroureterostomy, ureteral reimplantation and ureteral reimplantation with Boari flap creation to demonstrate how location and length dictate the appropriate surgical management in three instances of benign ureteral stricture disease.

The patients underwent uretero-ureterostomy, ureteral neocystostomy, and Boari flap reconstruction, respectively, all with a robotic assisted laparoscopic technique. The operation was performed utilizing a modified flank position in the first patient and supine position in the remaining two patients. After mobilization of surrounding structures and exposure of the ureter, the diseased segment was excised and spatulated, and a water-tight, tension free anastomosis was created.

The use of a robotic assisted approach allowed for successful reconstruction with minimal morbidity and rapid convalescence in all three instances.

With strict adherence to the principles of open ureteral surgery, robotic ureteral reconstruction is safe and feasible and provides patients the option of a minimally invasive approach to treat benign stricture disease of the ureter.

Funding: This study was funded by the Rush University Medical Center Department of Urology. No outside funding was received.