V4-10: ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: OUR TECNIQUE AND OUTCOMES
VideoIntroductions and Objectives
Robotic assistance has facilitated performance of many complex reconstructive procedures previously relegated to an open approach with numerous reported advantages. Distal ureteral reconstruction and reimplantation is one such procedure which is now often performed laparoscopically with robotic assistance using the da Vinci robotic surgical system. We evaluated perioperative and long-term outcomes among patients who underwent treatment with robotic-assisted laparoscopic ureteral reimplantation (RALUR) at a single center.
Patients who underwent RALUR between 7/2006 and 10/2012 were identified. In all procedures, the distal ureter was spatulated for 1.5 centimeters. An approximately 1 centimeter cystotomy was created. The ureterovesical anastomosis was completed in a triangular fashion including two arms of 4-0 PDS suture up the sides of the spatulation and a third arm anteriorly following stent placement to form a widely patent, refluxing anastomosis. All procedures were performed at a single institution. A retrospective review of perioperative and clinical data was performed assessing operative time, estimated blood loss, length of admission, and success of procedure as indicated by the absence of obstruction on follow-up imaging.
A total of 21 patients underwent RALUR in the study period. Mean age of patients was 43.2 years. 20 of the 21 RALUR were completed robotically with conversion to open in one patient. Etiology of injury included 11 due to gynecologic procedural injury and three secondary to iatrogenic ureteral injuries. The remainder were comprised of congenital, non-gynecologic surgery, radiation, and idiopathic. 13 required psoas hitch procedure as well. Mean operative time was 237 minutes. Mean estimated blood loss was 85cc. Mean length of hospital admission was 3.1 days. Currently, all patients remain non-obstructed by Lasix renogram at mean follow-up of 12.4 months.
RALUR with psoas hitch (when indicated) is a safe and effective option for distal ureteral reconstruction. Further investigation will help to more clearly refine patient selection and delineate patient benefits in comparison to an open procedure.